Acoustic neuroma differential diagnosis: Difference between revisions

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{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}}{{Simrat}}
==Overview==
==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==
==Differential Diagnosis==
The most frequent differential to be considered are:
The most frequent differential to be considered are:
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease/Condition}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differentiating Symptoms/Signs}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differentiating Signs/Symptoms }}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differentiating Tests}}
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Findings on CT or MRI}}


|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Normal (person who does not have hemophilia)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningioma
| style="padding: 5px 5px; background: #F5F5F5;" |50% to 100%
| style="padding: 5px 5px; background: #F5F5F5;" |Hearing loss is a less prominent
| style="padding: 5px 5px; background: #F5F5F5;" |50% to 100%
| style="padding: 5px 5px; background: #F5F5F5;" |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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Mild hemophilia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Epidermoid
| style="padding: 5px 5px; background: #F5F5F5;" |Greater than 5% but less than 50%
| style="padding: 5px 5px; background: #F5F5F5;" |Hearing loss is a less prominent
| style="padding: 5px 5px; background: #F5F5F5;" |50% to 100%
| style="padding: 5px 5px; background: #F5F5F5;" |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)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Moderate hemophilia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Facial nerve Schwannoma
| style="padding: 5px 5px; background: #F5F5F5;" |1% to 5%
| style="padding: 5px 5px; background: #F5F5F5;" |Facial weakness is prominent and occurs early
| style="padding: 5px 5px; background: #F5F5F5;" |50% to 100%
Sometimes associated with neurofibromatosis
| style="padding: 5px 5px; background: #F5F5F5;" |CT and 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: #DCDCDC; font-weight: bold" | Severe hemophilia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Trigeminal Schwannoma
| style="padding: 5px 5px; background: #F5F5F5;" |Less than 1%
| style="padding: 5px 5px; background: #F5F5F5;" |Clinically associated with more prominent facial numbness
| style="padding: 5px 5px; background: #F5F5F5;" |50% to 100%
Hearing loss is also less prominent
| style="padding: 5px 5px; background: #F5F5F5;" |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)
|}
|}
*Meningioma
 
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)
Other Differential diagnosis and their findings include:
meningiomas tend to have a broad dural base
*Ependymoma
usually lack trumpet IAM sign
*Metastasis
calcification more common
*Leiomyoma
epidermoid
*Intranodal palisaded myofibroblastoma
no enhancing component
*Gastrointestinal stromal tumor
very high signal on DWI
*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>
does not widen the IAC
*Neurofibroma
metastasis
*Meniere's disease
uncommon
*Bell's palsy
usually does not remodel the IAC as metastases are usually present for only a short time
ependymoma
centered on the fourth ventricle
does not extend into the IAC
usually younger patients


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 19:25, 16 September 2015

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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

  1. 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.