Acoustic neuroma differential diagnosis

Revision as of 19:25, 16 September 2015 by Simrat Sarai (talk | contribs)
Jump to navigation Jump to search

Acoustic neuroma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acoustic neuroma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acoustic neuroma differential diagnosis On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acoustic neuroma differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acoustic neuroma differential diagnosis

CDC on Acoustic neuroma differential diagnosis

Acoustic neuroma differential diagnosis in the news

Blogs on Acoustic neuroma differential diagnosis

Directions to Hospitals Treating Acoustic neuroma

Risk calculators and risk factors for Acoustic neuroma differential diagnosis

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.