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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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surprised by this case, because the patient came to our
attention complaining of very different symptoms:
only a careful clinical history and a complete physical
examination raised the suspicion of a serious disease,
that induced to further investigate on the patient by
imaging. When we found the spontaneous nystagmus
associated with relatively poor symptoms, we initially
thought an episode of vestibular neuronytis. However,
due the associated hearing loss, this hypothesis was
discarded. So we thought of an attack of
endolymphatic hydrops, but it is unlikely that the
instability can last so long (1 month), with no
associated tinnitus and vertigo. A thorough
investigation with imaging techniques was then
planned: CT first, and then MRI, that can not be
carried out in emergency in our Country. These
imaging methods are essential for the diagnosis, but
we want to stress the concept that, among the many
causes of vertigo, we must never forget the VS. We
must always keep in mind it while preparing
anamnesis and physical examination, even when
dealing with so-called “non-patients”, because these
are the prerequisite for the diagnosis of VS.
Conclusion
- Vestibular schwannoma (VS) is a rare and benign
tumor, originating from Schwann cells of vestibular
component of eighth cranial nerve
- Gold standard for diagnosis of VS is MRI
- Whereas diagnosis of VS is often occasional, you
must always think about it, when examining a dizzy
patient, especially in the case of asymmetric
sensorineural hearing loss.
- Whereas VS tends to give only late clinical
manifestations, you can visit a patient with VS, which
consults you for a totally different problem.
- Don’t forget the importance of a good and complete
clinical history and physical examination.
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