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], 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]

Differentiating features of common differential diagnosis are:[1]

Differentiating features of common differential diagnosis
Disease/Condition Differentiating Signs/Symptoms Findings on CT or MRI
Meningioma
  • Hearing loss is less common
  • 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 is more common
Intracranial epidermoid cyst
  • Hearing loss is less common
  • No enhancing component
  • Very high signal on DWI (Diffusion weighted imaging)
  • Does not widen the IAC (Internal auditory canal)
Facial nerve schwannoma
  • Facial weakness is common 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 facial numbness
  • Hearing loss is less common
  • 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)

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 fontcolor|#FFF|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
CPA or petrous meningiomas Functional Conversion disorder
CPA or petrous apex metastases Malingering
CPA 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. 1.0 1.1 Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
  2. Schwannoma. Librepathology(2015) http://librepathology.org/wiki/index.php/Schwannoma Accessed on October 2 2015
  3. Chan PT, Tripathi S, Low SE, Robinson LQ (2007). "Case report--ancient schwannoma of the scrotum.". BMC Urol. 7: 1. PMC 1783662Freely accessible. PMID 17244372. doi:10.1186/1471-2490-7-1. 
  4. 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. 
  5. A. M611er, A. Hatam and H. Olivecrona (1978). "The Differential Diagnosis of Pontine Angle Meningioma and Acoustic Neuroma with Computed Tomography". Neuroradilogy. 

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