Acoustic neuroma differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Acoustic neuroma must be differentiated from Meningioma, epidermoid, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomymoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour(MPNST), gastrointestinal stromal tumor, neurofibroma, meniere's disease, and bell's palsy.
Differential Diagnosis
The most frequent differential to be considered are:
| Disease/Condition | Differentiating Signs/Symptoms | Findings on CT or MRI |
|---|---|---|
| Meningioma | Hearing loss is a less prominent | usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)
meningiomas tend to have a broad dural base usually lack trumpet IAM sign calcification more common |
| Epidermoid | Hearing loss is a less prominent | no enhancing component
very high signal on DWI. (Diffusion weighted imaging (DWI) is a form of MR imaging based upon measuring the random Brownian motion of water molecules within a voxel of tissue) does not widen the IAC (Internal Auditory Canal) |
| Facial nerve Schwannoma | Facial weakness is prominent and occurs early
Sometimes associated with neurofibromatosis |
CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal |
| Trigeminal Schwannoma | Clinically associated with more prominent facial numbness
Hearing loss is also less prominent |
CT and MRI imaging displays 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 IAM (internal acoustic meatus) |
Other Differential diagnosis and their findings include:
- Ependymoma
- Metastasis
- Leiomyoma
- Intranodal palisaded myofibroblastoma
- Gastrointestinal stromal tumor
- MPNST - schwannoma with ancient change has no significant mitotic activity[1]
- Neurofibroma
- Meniere's disease
- Bell's palsy
References
- ↑ 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.