Image IQ: 65-year old Male, Left Sensorineural Hearing Loss
Published on Diagnostic Imaging (http://www.diagnosticimaging.com)
Image IQ: 65-year old Male, Left Sensorineural Hearing Loss
Image IQ [1] | April 14, 2016 | MRI [2], Brain MRI [3]
By Akemi D. Miller, MD [4] and Erini V. Makariou, MD [5]
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Image IQ: 65-year old Male, Left Sensorineural Hearing Loss
Published on Diagnostic Imaging (http://www.diagnosticimaging.com)
65-year-old male presents with left sensorineural hearing loss.
Click on the images to enlarge.
What's your diagnosis?
Choices
❍ Vestibular schwannoma
❍ Lipoma
❍ Intralabyrinthine hemorrhage
❍ Acute labyrinthitis
Vote
Acute labyrinthitis
40% (554 votes)
Vestibular schwannoma
28% (381 votes)
Lipoma
7% (100 votes)
Intralabyrinthine hemorrhage
25% (340 votes)
Total votes: 1375
Answer: Vestibular schwannoma
Imaging Characteristics
MRI images demonstrate an avidly enhancing, T1-isointense, T2-hypointense lesion in the basal turn
of the cochlea, characteristic of schwannoma. The T2 hypointesity appears as a filling defect within
the surrounding hyperintense perilymph fluid.
Acute labyrinthitis is characterized by T1 hyperintense signal secondary to permeability of the
blood-labyrinth barrier and accumulation in the intralabyrinthine compartment. Post-gadolinium
T1-weighted images demonstrate diffuse, but faint, enhancement of the labyrinth. Intravestibular
lipomas are nonenhancing and demonstrate T1 hyperintense, T2-iso, or hypointense signal with
complete saturation on fat-saturation images. Intralabyrinthine hemorrhage is characterized by both
T1- and T2-hyperintense signal on precontrast sequences.
Discussion
Vestibular schwannoma is a benign nerve sheath neoplasm derived from perineural Schwann cells.
They are similar in pathology to peripheral schwannomas and comprise approximately 8% of adult
intracranial tumors. Median age at diagnosis is 50, and they are rare in children unless associated
with neurofibromatosis type 2 (NF2). The majority of these tumors (90%) are unilateral, with bilateral
involvement characteristic of NF2. In sporadic cases, there is often biallelic inactivation of the NF2
gene, which produces schwannomin and serves as a tumor suppressor. Childhood exposure to
radiation increases the risk for developing vestibular schwannoma in later life.
Presenting symptoms include hearing loss and tinnitus (cochlear nerve) or unsteady gait and vertigo
(vestibular nerve) depending on the affected nerve.
Patients who are young, have large tumors and/or significant hearing loss should be treated early to
prevent progressive hearing loss. In older patients with small tumors and minimal hearing loss, rate
of growth may be used to guide treatment, with rapid growth defined as > 2.5 mm per year.
References
1. Park JK, Vernick DM, Ramakrishma N. Vestibular schwannoma (acoustic neuroma).
http://www.uptodate.com/contents/vestibular-schwannoma-acoustic-neuroma [11]
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Image IQ: 65-year old Male, Left Sensorineural Hearing Loss
Published on Diagnostic Imaging (http://www.diagnosticimaging.com)
2. Salzman KL, et al. Intralabyrinthine schwannomas: imaging diagnosis and classification. AJNR.
2012;33:104–109.
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65-year-old male presents with left sensorineural hearing loss.
Click on the images to enlarge.
What's your diagnosis?
* Acute labyrinthitis
* Vestibular schwannoma
* Lipoma
* Intralabyrinthine hemorrhage
Vote
Image IQ: 65-year old Male, Left Sensorineural
Hearing Loss
Image IQ: 65-year old Male, Left Sensorineural
Hearing Loss
Image IQ: 65-year old Male, Left Sensorineural
Hearing Loss
Image IQ: 65-year old Male, Left Sensorineural
Hearing Loss
Image IQ: 65-year old Male, Left Sensorineural
Page 3 of 4
Image IQ: 65-year old Male, Left Sensorineural Hearing Loss
Published on Diagnostic Imaging (http://www.diagnosticimaging.com)
Hearing Loss
Source URL:
http://www.diagnosticimaging.com/mri/image-iq-65-year-old-male-left-sensorineural-hearing-loss
Links:
[1] http://www.diagnosticimaging.com/image-iq
[2] http://www.diagnosticimaging.com/mri
[3] http://www.diagnosticimaging.com/brain-mri
[4] http://www.diagnosticimaging.com/authors/akemi-d-miller-md
[5] http://www.diagnosticimaging.com/authors/erini-v-makariou-md
[6] http://www.diagnosticimaging.com/sites/default/files/Fig%201_4.jpg
[7] http://www.diagnosticimaging.com/sites/default/files/Fig-2.jpg
[8] http://www.diagnosticimaging.com/sites/default/files/Fig-3.jpg
[9] http://www.diagnosticimaging.com/sites/default/files/Fig-4.jpg
[10] http://www.diagnosticimaging.com/sites/default/files/Fig-5.jpg
[11] http://www.uptodate.com/contents/vestibular-schwannoma-acoustic-neuroma
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