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International Journal of Clinical Case Reports 2014, Vol. 4, No. 6, 1-4
http://ijccr.biopublisher.ca
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Vestibular Schwannoma: An occasional diagnosis during an occasional examination
Enrico Maria Amadei , Antonio Pirodda
Department of Otorhinolaryngology, Head and Neck Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
Corresponding author email:
enricomaria.amadei@libero.it
,
International Journal of Clinical Case Reports, 2014, Vol.4, No.6 doi: 10.5376/ijccr.2014.04.0006
Received: 25 Mar., 2014
Accepted: 28 May., 2014
Published: 24 Jul., 2014
© 2014 Amadei and Pirodda. This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Amadei and Pirodda, 2014, Vestibular Schwannoma: An occasional diagnosis during an occasional examination, International Journal of Clinical Case Reports,
Vol.4, No.6, 1-4
(doi: 10.5376/ijccr.2014.04.0006)
Abstract
Introduction
: Vestibular schwannoma (VS) is a rare and benign tumor originating from Schwann cells of the vestibular component
of the eighth cranial nerve, which tends to give only late clinical manifestations. In general its diagnosis is late or occasional.
Case
: We present the case of a 56-year-old woman who complained for difficult nasal breathing. It seemed to be a simple case of
congestion of nasal turbinates , but during clinical interview, a spontaneous nystagmus beating to the right was noted. Continuing
medical history, the patient reported an annoying right hearing loss and a slight dizziness which lasted from about 1 month.
So we performed an audiometric examination and a CT scan. Finally MRI with gadolinium showed an expansive lesion of the right
cerebellopontine angle with intra-extrameatal development, of 28 mm, and a large cystic intralesional component, compatible with an
eighth cranial nerve VS. The VS was macroscopically removed with surgery.
Discussion
: We explain an occasionally diagnosed case of VS. Although gold standard for its diagnosis is MRI, history and physical
examination should always be as complete and thorough as possible, even when we are dealing with patients so-called “non-patients”.
We say how we perform a vestibular visit and we make a review of recent literature, with the intention of providing basic information
on how to treat a dizzy patient.
Conclusion
: We want to emphasize the concept of never forget the VS, among the many causes of vertigo, and the importance for its
diagnosis covered by history and physical examination.
Keywords
Vestibular schwannoma; Cranial nerve; Rare tumor; Incidental diagnosis
Introduction
Vestibular Schwannoma (VS) is a rare (6%-8% of all
newly diagnosed brain tumors; about 20 cases per
million population diagnosed per year) (1) and benign
tumor typically originating from Schwann cells of
vestibular component of eighth cranial nerve. It tends
to give only late clinical manifestations, like hearing
loss, tinnitus, headache, vertigo and dizziness (2), and
often diagnosis is obtained on an occasional basis,
during a diagnostic imaging examination of head
possibly performed for other reasons.
When an asymmetry of sensorineural hearing loss is
ascertained, especially in presence of vestibular
associated symptoms, it is always important to
conduct a thorough investigation by brain imaging,
with an emphasis on cerebellopontine angle. Even if
the resort to techniques of neuro-imaging in such
situation is mandatory, the importance of a good and
complete clinical history and physical examination
must not be neglected.
Explaining an occasionally diagnosed case of VS, we
say how we perform a typical vestibular visit and we
make a review of recent literature, with the intention
of providing basic information on how to treat a dizzy
patient.
Case
We present the case of a 56-year-old woman who
comes to our attention, sent by the family physician
because of a difficult nasal breathing: it seemed to be
a typical case of “common symptoms with simple
treatment”. At examination, nasal cavity, nasopharynx
and oropharynx were evaluated, finding hypertrophy
of inferior turbinates, a moderate serous nasal
discharge and a picture of mild chronic pharyngitis.