Acoustic neuroma differential diagnosis: Difference between revisions
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Acoustic neuroma must be differentiated from:<ref name="libre">Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015</ref> | Acoustic neuroma must be differentiated from:<ref name="libre">Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015</ref> | ||
*[[Meningioma]] | *[[Meningioma]] | ||
*Intracranial | *[[Cranium|Intracranial]] [[epidermoid cyst]] | ||
*[[Facial nerve]] [[schwannoma]] | *[[Facial nerve]] [[schwannoma]] | ||
*[[Trigeminal]] schwannoma | *[[Trigeminal]] [[schwannoma]] | ||
*[[Ependymoma]] | *[[Ependymoma]] | ||
*[[Metastasis]] | *[[Metastasis]] | ||
*[[Leiomyoma]] | *[[Leiomyoma]] | ||
*Intranodal palisaded myofibroblastoma | *Intranodal palisaded myofibroblastoma | ||
*Gastrointestinal stromal tumor | *[[Gastrointestinal tract|Gastrointestinal]] [[stromal]] [[tumor]] | ||
*MPNST - schwannoma with ancient change has no significant [[mitotic]] activity<ref name="pmid17244372">{{cite journal| author=Chan PT, Tripathi S, Low SE, Robinson LQ| title=Case report--ancient schwannoma of the scrotum. | journal=BMC Urol | year= 2007 | volume= 7 | issue= | pages= 1 | pmid=17244372 | doi=10.1186/1471-2490-7-1 | pmc=PMC1783662 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17244372 }} </ref> | *MPNST - [[schwannoma]] with ancient change has no significant [[mitotic]] activity<ref name="pmid17244372">{{cite journal| author=Chan PT, Tripathi S, Low SE, Robinson LQ| title=Case report--ancient schwannoma of the scrotum. | journal=BMC Urol | year= 2007 | volume= 7 | issue= | pages= 1 | pmid=17244372 | doi=10.1186/1471-2490-7-1 | pmc=PMC1783662 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17244372 }} </ref> | ||
*[[Neurofibroma]] | *[[Neurofibroma]] | ||
*[[Meniere's]] | *[[Ménière's disease|Meniere's disease]] | ||
*[[Bell's palsy]] | *[[Bell's palsy]] | ||
Differentiating features of common differential | Differentiating features of common differential diagnoses are:<ref name="radio">Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref> | ||
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! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Meningioma | ! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Meningioma | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Hearing loss is less common | *[[Hearing impairment|Hearing loss]] is less common | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Usually more homogeneous in appearance: significant signal heterogeneity with cystic or | *Usually more [[Homogeneity|homogeneous]] in appearance: significant signal [[Heterogeneous|heterogeneity]] with [[Cyst|cystic]] or [[Bleeding|hemorrhagic]] areas is more typical of vestibular schwannoma than [[Meningioma|meningiomas]] (although [[Cyst|cystic]] [[Meningioma|meningiomas]] do occur) | ||
*Meningiomas tend to have a broad dural base | *[[Meningioma|Meningiomas]] tend to have a broad [[Dura mater|dural]] base | ||
*Usually lack | *Usually lack trumpeted [[Internal auditory meatus|internal acoustic meatus]] sign | ||
*Calcification is more common | *[[Calcification]] is more common | ||
|- | |- | ||
! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Intracranial epidermoid cyst | ! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Intracranial epidermoid cyst | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Hearing loss is less common | *[[Hearing impairment|Hearing loss]] is less common | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*No enhancing component | *No enhancing component | ||
*Very high signal on DWI (Diffusion weighted imaging) | *Very high signal on DWI (Diffusion weighted imaging) | ||
*Does not widen the | *Does not widen the internal auditory canal | ||
|- | |- | ||
! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Facial nerve schwannoma | ! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Facial nerve schwannoma | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Facial weakness is common and occurs early | *[[Face|Facial]] weakness is common and occurs early | ||
*Sometimes associated with neurofibromatosis | *Sometimes associated with [[neurofibromatosis]] | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal | *[[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]] imaging results are similar to acoustic neuroma but enhancement extends into the [[geniculate ganglion]] of the [[facial nerve]] and [[facial canal]] | ||
|- | |- | ||
! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Trigeminal schwannoma | ! style="padding: 5px 5px; background: #87CEFA; font-weight: bold" | Trigeminal schwannoma | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*Clinically associated with facial numbness | *Clinically associated with [[Face|facial]] numbness | ||
*Hearing loss is less common | *[[Hearing impairment|Hearing loss]] is less common | ||
| style="padding: 5px 5px; background: #f0f8ff;" | | | style="padding: 5px 5px; background: #f0f8ff;" | | ||
*CT and MRI imaging | *[[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]] imaging display a dumbbell-shaped mass over the petrous apex affecting Meckel cave. | ||
*The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the | *The [[trigeminal nerve]] enhancement extends [[Anatomical terms of location|proximal]] to the [[tumor]] and does not extend into the [[Internal auditory meatus|internal acoustic meatus]] | ||
|} | |} | ||
Revision as of 17:19, 23 April 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2], Arash Azhideh,
Overview
Acoustic neuroma must be differentiated from meningioma, intracranial epidermoid cyst, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomyoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour (MPNST), gastrointestinal stromal tumor, neurofibroma, Meniere's disease, and Bell's palsy.[1]
Differential Diagnosis
Acoustic neuroma must be differentiated from:[2]
- Meningioma
- Intracranial epidermoid cyst
- Facial nerve schwannoma
- Trigeminal schwannoma
- Ependymoma
- Metastasis
- Leiomyoma
- Intranodal palisaded myofibroblastoma
- Gastrointestinal stromal tumor
- MPNST - schwannoma with ancient change has no significant mitotic activity[3]
- Neurofibroma
- Meniere's disease
- Bell's palsy
Differentiating features of common differential diagnoses are:[1]
| Differentiating features of common differential diagnosis | ||
|---|---|---|
| Disease/Condition | Differentiating Signs/Symptoms | Findings on CT or MRI |
| Meningioma |
|
|
| Intracranial epidermoid cyst |
|
|
| Facial nerve schwannoma |
|
|
| Trigeminal schwannoma |
|
|
Differential diagnosis for SSNHL:
Since the most common cause of Acoustic Neuroma is hearing loss, the differential diagnosis for SSNHL (Sudden Sensorineural Hearing Loss ) are listed below.[4]
| Identifiable Causes of Sudden Sensorineural Hearing Loss | |||
|---|---|---|---|
| Autoimmune | Autoimmune inner ear disease | Neurologic | Migraine |
| Behcet’s disease | Multiple sclerosis | ||
| Cogan’s syndrome | Pontine ischemia | ||
| Systemic lupus erythematosis | Otologic | Fluctuating hearing loss | |
| Infectious | Bacterial Meningitis | Meniere’s disease | |
| Cryptococcal meningitis | Otosclerosis | ||
| HIV | Enlarged vestibular aqueduct | ||
| Lassa fever | Toxic | Aminoglycosides | |
| Lyme disease | Chemotherapeutic agents | ||
| Mumps | Non-steroidal anti-inflammatories | ||
| Mycoplasma | Salicylates | ||
| Syphilis | Traumatic | Inner ear concussion | |
| Toxoplasmosis | Iatrogenic trauma/surgery | ||
| Vascular | Cardiovascular bypass | Perilymphatic fistula | |
| Temporal bone fracture | Cerebrovascular accident/stroke | ||
| Sickle cell disease | Metabolic | Diabetes mellitus | |
| Neoplastic | Acoustic neuroma | Hypothyroidism | |
| Cerebellopontine angle or petrous meningiomas | Functional | Conversion disorder | |
| Cerebellopontine angle or petrous apex metastases | Malingering | ||
| Cerebellopontine angle myeloma | |||
Differentiating Acoustic Neuroma from Meningioma in CT Scans
The most important differential diagnosis for Acoustic neuroma is Meningioma of Pontine angle, so it is vital to distinguish these two diseases. As you see below this diagram demonstrate this differences of these two disease in CT Scan.[5]
| <13cm3 | Volume | >35cm3 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Increased attenuation | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Marked calcification | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Oval shape | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | Round shape | Mostly No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acoustic Neuroma | No | Tumor reaches dorsum sellae anteriorly | Yes | Meningioma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mostly No | Apparently broad attachment to bone | Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Center of tumor anterior to porus | Sometimes Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Tumor reaches > 2 cm above dorsum | Mostly Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sometimes | Peripheral edema | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mostly Yes | Widening of porus or other bone changes | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
- ↑ Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015
- ↑ Chan PT, Tripathi S, Low SE, Robinson LQ (2007). "Case report--ancient schwannoma of the scrotum". BMC Urol. 7: 1. doi:10.1186/1471-2490-7-1. PMC 1783662. PMID 17244372.
- ↑ Maggie Kuhn, MD, Selena E. Heman-Ackah, MD, MBA, Jamil A. Shaikh, BA, and Pamela C. Roehm, MD, PhD (2011). "Sudden Sensorineural Hearing Loss: A Review of Diagnosis, Treatment, and Prognosis". Sagepub.
- ↑ A. M611er, A. Hatam and H. Olivecrona (1978). "The Differential Diagnosis of Pontine Angle Meningioma and Acoustic Neuroma with Computed Tomography". Neuroradilogy.