Cases reported "Neuroma, Acoustic"

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1/31. Acoustic neuroma surgery in geriatric patients.

    patients older than 65 years who develop acoustic neuromas have the same signs and symptoms as younger patients. Age limits beyond which surgery for acoustic neuroma is currently not recommended are unreasonable. Untreated vertigo in older patients frequently results in falls that can cause fracture of the femur and significant morbidity and mortality. Surgical removal of acoustic neuromas in patients older than 65 produces results that are as good as those seen in younger patients. The patient's general medical condition, life expectancy, and factors other than chronological age should be considered when surgery is being contemplated. Acoustic neuroma surgery for the older patient can provide gratifying results and should not be withheld strictly on the basis of age.
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2/31. Haemorrhagic acoustic neuroma with features of a vascular malformation. A case report.

    A 55-year-old man with hearing loss presented with vertigo and vomiting. CT tomography and MRI demonstrated a cerebellopontine angle mass with foci of haemorrhage. An angiomatous tumour, with large abnormal veins adhering to the capsule, was completely removed. Histologically, the tumour was an acoustic neuroma with abnormal vascularisation and limited intratumoral haemorrhage.
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3/31. Relationship between cystic change and rotatory vertigo in patients with acoustic neuroma.

    Acoustic neuromas are benign neoplasms that most often arise from the vestibular nerve. Many patients with this tumor experience some degree of vestibular symptoms. However, patients rarely complain of rotatory vertigo. Acoustic neuromas are known to exhibit a cystic appearance in some patients. It was hypothesized that cystic change might be a causative factor for rotatory vertigo. A retrospective study of 178 patients with unilateral acoustic neuroma who underwent surgery in the Department of otolaryngology at tokyo Medical and Dental University was carried out. The cystic appearance of the tumors was detected preoperatively by magnetic resonance imaging and confirmed at surgery. The relationship between cystic change of the tumor and presentation with rotatory vertigo was examined. Of the 178 patients studied, only 10 had both cystic change of the tumor and rotatory vertigo, and 120 had neither cystic tumor nor rotatory vertigo. Of the remaining 48 patients, 24 experienced rotatory vertigo with negative findings for cystic tumor and the other 24 had evidence of cystic tumor but no rotatory vertigo. Tumor with cystic change was observed in 34 patients, accounting for 19.1% of all patients studied. Rotatory vertigo was also experienced in 34 patients (19.1%). Of the 34 patients with cystic lesions, 29.4% (10) had rotatory vertigo. The difference in percentage of the two groups did not reach statistical significance. It is suggested that there may be other factors causing rotatory vertigo in patients with acoustic neuromas than cystic change of the tumor.
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ranking = 14
keywords = vertigo
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4/31. An intramural macrocyst of an acoustic neurinoma rupturing after gamma knife radiosurgery: a case report.

    We want to describe the rare case when an intramural macrocyst within an acoustic neurinoma (ACN) treated by gamma knife radiosurgery (GKRS) ruptured, followed by an impressive decrease of tumor volume and improvement of neurological symptoms. In a 59-year-old female patient, a large ACN with a hugh intramural macrocyst was diagnosed. As she refused open surgery, we performed GKRS covering the tumor margin and the cyst with 11 Gy. Seven months after treatment symptoms worsened slightly. magnetic resonance imaging (MRI) revealed no significant change of tumor volume. One year after GKRS she felt a sensation behind her treated ear, followed by an immediate improvement of all her symptoms. Trigeminal hypaesthesia and vertigo disappeared, tinnitus ameliorated. A control MRI showed the cystic compartment no longer, the solid part shrunk within the following six years. Within the whole follow-up period hearing was stable. To our knowledge this is the first report of a macrocyst within an ACN to rupture after GKRS.
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keywords = vertigo
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5/31. magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo.

    OBJECTIVE: The etiopathogenesis in audiovestibular symptoms can be elusive, despite extensive differential diagnosis. This article addresses the value of magnetic resonance imaging (MRI) in analysis of the complete audiovestibular pathway. STUDY DESIGN: Retrospective evaluation. SETTING: Tertiary referral center. patients: Consecutive sample of 354 patients (mean age 49 years, range 8 to 86 years) with audiovestibular disorders. INTERVENTION: Contrast-enhanced MRI of the head with thin-slice investigation of the inner ear, internal auditory meatus, and cerebellopontine angle. MAIN OUTCOME MEASURE: All MRIs were evaluated by experienced independent investigators. Statistical analysis was performed using the Statistical Package of social sciences data analysis 9.0. RESULTS: MRI abnormalities were seen in 122 of 354 patients (34.5%). The MRIs revealed the following: 4 pathologic conditions (1.1%) of the cochlea/labyrinth, 23 abnormalities (6.5%) at the internal auditory meatus/cerebellopontine angle, 12 pathologic lesions (3.4%) that involved the central audiovestibular tract at the brainstem, 78 microangiopathic changes of the brain (22%), 3 focal hyperintensities of the brain that turned out to be the first evidence of multiple sclerosis in 2 patients and sarcoidosis in 1 patient, and 1 temporal metastasis. Other pathologic conditions, such as parotid gland or petrous bone apex tumors, were unrelated to the audiovestibular symptoms. CONCLUSIONS: This study indicates that contrast-enhanced MRI can be used to assess a significant number of different pathologic conditions in patients with audiovestibular disorders.
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keywords = vertigo
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6/31. Co-existing cholesteatoma and vestibular schwannoma.

    A 69-year-old man presented with a cholesteatoma in the right mastoid process and a vestibular schwannoma at the left internal acoustic meatus. cholesteatoma co-existing with a vestibular schwannoma has not been documented previously in the contemporary literature. The clinical dilemma in the management of his progressive bilateral hearing loss is discussed. He presented with dizziness and bilateral hearing loss worse on the right side. pressure over the mastoid process elicited vertigo and nystagmus. He had no history of previous operation or infection in the ear canal. Audiograms confirmed high-tone hearing loss. Radiological investigations revealed a symptomatic cholesteatoma on the right side and an incidental vestibular schwannoma on the left. We have elected to manage both lesions conservatively. Bilateral cholesteatoma and bilateral vestibular schwannomas have been previously reported. Co-existing lesions, as in our patient have, however, not been reported previously. The management options of his hearing loss are discussed.
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ranking = 1
keywords = vertigo
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7/31. Acoustic neuroma presenting as exercise-induced vertigo.

    We present two subjects with previously undiagnosed acoustic neuromas who complained of vertigo whenever they ran. One had normal hearing while the other already had a unilateral sensorineural deafness. hyperventilation for 30 seconds provoked an ipsilateral beating nystagmus and reproduced the vertiginous sensation in both subjects. hyperventilation is a simple bedside test that should be performed when assessing a subject with vertigo or when there is a clinical suspicion of an acoustic neuroma.
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ranking = 6
keywords = vertigo
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8/31. Differentiation between cerebellopontine angle tumors in cancer patients.

    OBJECTIVE: The possibility of metastasis to the cerebellopontine angle should be considered when a cancer patient has inner ear-related symptoms, although such metastasis is rare. Distinguishing between an independent tumor and a metastasis presents a challenge to the clinician once magnetic resonance imaging reveals a space-occupying lesion in the cerebellopontine angle. This study attempted to differentiate between primary benign and metastatic malignant cerebellopontine angle tumors in cancer patients. SETTING: University hospital. patients: A total of 174 cancer patients with inner ear-related symptoms such as vertigo, hearing loss, or tinnitus were seen at the university hospital from January 1994 to December 2000. All patients underwent a battery of audiologic and neurotologic tests. magnetic resonance imaging was performed either when the clinical presentation suggested vertigo of central origin or when sensorineural hearing loss developed. RESULTS: magnetic resonance imaging confirmed tumors of the cerebellopontine angle in 6 (3%) of the 174 patients, including 3 men and 3 women. Their ages ranged from 46 to 80 years (mean 62 years). The final diagnoses were breast cancer with cerebellopontine angle metastasis (1), breast cancer with cerebellopontine angle epidermoid cyst (1), colon cancer with cerebellopontine angle metastasis (1), colon cancer with acoustic neuroma (1), nasopharyngeal carcinoma with cerebellopontine angle metastasis (1), and nasopharyngeal carcinoma with cerebellopontine angle benign tumor (1). CONCLUSIONS: When a cerebellopontine angle tumor is discovered in a cancer patient, metastatic cancer should be suspected when the tumor presents with deficits of the VIIth and VIIIth cranial nerves of rapid progression or bilateral involvement, or extracranial systemic metastasis. Laboratory examinations such as cytologic study of the cerebrospinal fluid and serologic study can assist in the diagnosis.
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ranking = 2
keywords = vertigo
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9/31. Intralabyrinthine schwannomas.

    OBJECTIVE: To describe the patient presentation, radiographic findings, and treatment results in a series of eight patients with a diagnosis of intralabyrinthine schwannoma, and to review the presentation of other cases of intralabyrinthine schwannoma in the English otolaryngologic literature. methods: Retrospective review of patient records, operative reports, and radiologic studies, and review of the literature. RESULTS: Eight patients with a variety of otologic symptoms including progressive hearing loss, episodic vertigo, and tinnitus were found to have a schwannoma involving the vestibule or cochlea. Surgery was performed to remove the tumors from four patients with nonserviceable hearing. The patients experienced significant improvement in their vertigo and tinnitus after surgery. observation and serial magnetic resonance imaging were adequate treatment of the four patients with serviceable hearing. In the literature review, 447 cases of intralabyrinthine schwannoma were identified, and the presentations were similar to those in the cases described here. CONCLUSION: Intralabyrinthine schwannomas are rare tumors that arise from the distal portion of either the vestibular nerve or the cochlear nerve. Consequently, the cochlea, the semicircular canals, the vestibule, or a combination of these structures may become involved with these lesions. Transmastoid labyrinthectomy or a transotic approach can be used to remove intralabyrinthine tumors from patients with nonserviceable hearing and severe vertigo or tinnitus. In addition, these surgical approaches should be used if the tumor grows to involve the internal auditory canal. observation is an appropriate option for patients who have serviceable hearing.
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ranking = 3
keywords = vertigo
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10/31. Metastatic lung cancer in the cerebellopontine angles mimicking bilateral acoustic neuroma.

    Bilateral cerebellopontine angle (CPA) tumors identified on MRI are considered bilateral acoustic neuromas, the definitive diagnostic criterion of neurofibromatosis 2 (NF-2). We report the case of a 67-year-old man with progressive bilateral hearing loss, vertigo, and imbalance. MRI revealed bilateral enhancing CPA lesions, which were suggestive of acoustic neuromas and a diagnosis of NF-2. However, autopsy showed metastatic adenocarcinoma of the lung. Therefore, metastatic carcinoma to the CPA can mimic bilateral acoustic neuromas; imaging studies alone may be insufficient to diagnose NF-2.
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keywords = vertigo
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