scholarly journals A Trigeminal Schwannoma Masked by Solely Vestibulocochlear Symptoms

2020 ◽  
Vol 31 (06) ◽  
pp. 449-454
Author(s):  
Lauran K. Evans ◽  
Lazaro Peraza ◽  
Anthony Zamboni
Keyword(s):  
Hearing Loss ◽  
Retrospective Chart Review ◽  
Diagnostic Error ◽  
External Compression ◽  
Vestibulocochlear Nerve ◽  
Record Keeping ◽  
Trigeminal Schwannoma ◽  
Imaging Results ◽  
Magnetic Resonance Imaging Mri ◽  
Asymmetric Sensorineural Hearing Loss

Abstract Background Intracranial schwannomas are most commonly associated with the vestibulocochlear nerve, often leading to hearing loss, tinnitus, and vestibular dysfunction. Much less often, a schwannoma can arise from the trigeminal nerve which can lead to facial pain, numbness, and weakness. Purpose We explored a case of a patient with an magnetic resonance imaging (MRI)-confirmed trigeminal schwannoma that was mistaken for a vestibulocochlear schwannoma because of a myriad of ipsilateral vestibulocochlear symptoms. Research Design This is a retrospective chart review and case study, with no statistics applied. Results This diagnostic error led to clinical confusion and inaccurate medical record-keeping. Radiologists and radiation oncologists deemed the patient's symptoms to be unrelated to the asymptomatic trigeminal schwannoma, and she was referred to an otolaryngologist following complaints of ear fullness, ear pain, and hearing loss. The patient's audiogram showed ipsilateral, asymmetric sensorineural hearing loss, and she was diagnosed with concurrent Meniere's disease. Alternative explanations, such as an additional schwannoma or external compression of the vestibulocochlear nerve, were considered, but not apparent on MRI. Conclusions From this case, we see that symptoms do not always concur with imaging results and that multiple etiologies, especially when one is rare, can confuse a clinical picture.

A Trigeminal Schwannoma Masked by Solely Vestibulocochlear Symptoms

2019 ◽  
Author(s):  
Lauran K. Evans ◽  
Lazaro Peraza ◽  
Anthony Zamboni
Keyword(s):  
Hearing Loss ◽  
Retrospective Chart Review ◽  
Diagnostic Error ◽  
External Compression ◽  
Vestibulocochlear Nerve ◽  
Record Keeping ◽  
Trigeminal Schwannoma ◽  
Imaging Results ◽  
Magnetic Resonance Imaging Mri

Background: Intracranial schwannomas are most commonly associated with the vestibulocochlearnerve, often leading to hearing loss, tinnitus, and vestibular dysfunction. Much less often, a schwannomacan arise from the trigeminal nerve which can lead to facial pain, numbness, and weakness.<br />Purpose: We explored a case of a patient with an magnetic resonance imaging (MRI)-confirmed trigeminalschwannoma that was mistaken for a vestibulocochlear schwannoma because of a myriad of ipsilateralvestibulocochlear symptoms.<br />Research Design: This is a retrospective chart review and case study, with no statistics applied.<br />Results: This diagnostic error led to clinical confusion and inaccurate medical record-keeping. Radiologistsand radiation oncologists deemed the patient’s symptoms to be unrelated to the asymptomatictrigeminal schwannoma, and she was referred to an otolaryngologist following complaints of ear fullness,ear pain, and hearing loss. The patient’s audiogram showed ipsilateral, asymmetric sensorineural hearingloss, and she was diagnosed with concurrent Meniere’s disease. Alternative explanations, such as anadditional schwannoma or external compression of the vestibulocochlear nerve, were considered, but notapparent on MRI.<br />Conclusions: From this case, we see that symptoms do not always concur with imaging results and thatmultiple etiologies, especially when one is rare, can confuse a clinical picture.<br />

The Value of Brain Imaging in Children With Headaches

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 413-416
Author(s):  
Joseph Maytal ◽  
Robert S. Bienkowski ◽  
Mahendra Patel ◽  
Lydia Eviatar
Keyword(s):  
Brain Tumors ◽  
Brain Imaging ◽  
Retrospective Chart Review ◽  
Imaging Studies ◽  
Mri Studies ◽  
Imaging Results ◽  
Neurology Clinic ◽  
Magnetic Resonance Imaging Mri ◽  
Chronic Headaches ◽  
Atypical Headache

Objective. To determine the value of performing computed tomography (CT) or magnetic resonance imaging (MRI) studies in children with chronic headaches. Background. Headache is a common complaint in children, With the proliferation of brain imaging centers and the increasing patient demand for CT or MRI studies, brain imaging has become widely used to evaluate headaches. Methods. A retrospective chart review was conducted of all children referred to the pediatric neurology clinic for evaluation of headaches over a 2-year period. Charts were reviewed for headache characteristics, clinical indications for performing CT and MRI studies, and imaging results. Particular attention was paid to evidence of brain tumors, vascular anomalies, or hydrocephalus. Results. A total of 133 records were studied. Subjects ranged in age from 3 to 18 years. Most patients were diagnosed as having either vascular migrainous headaches (52%) or chronic tension headaches (21%). Other headache diagnoses were mixed tension-migraine, psychogenic, and post-traumatic. Headaches were unclassified in 25 patients (19%). Seventy-eight patients (59%) had brain imaging: 45 had MRI, 27 had CT, and 6 patients had both. In most cases, brain imaging studies were performed in patients with atypical headache pattern, presence of neurologic abnormalities during the headache, general symptoms (ie, weight loss or fatigue), or because of parents' or doctors' concerns about brain tumors. Cerebral abnormalities were found on brain imaging in four patients, but none indicated the presence of a treatable disease and all were deemed unrelated to the presenting complaint. Our findings of no relevant abnormalities in a series of 78 brain imaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 3.8%. Conclusions. These results indicate that brain imaging studies have very limited value in evaluating headaches in pediatric patients without clinical evidence of an underlying structural lesion.

scholarly journals Denervation of the Eustachian Tube and Hearing Loss Following Trigeminal Schwannoma Resection

2016 ◽  
Vol 77 (01) ◽  
pp. e56-e61 ◽  
Author(s):  
Alexander Malone ◽  
Ricky Wong ◽  
Harry van Loveren ◽  
K. Boyev ◽  
Christopher Ito
Keyword(s):  
Hearing Loss ◽  
Eustachian Tube ◽  
Trigeminal Schwannoma

scholarly journals Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study

2017 ◽  
Vol 06 (04) ◽  
pp. 276-279 ◽  
Author(s):  
Erin Nance ◽  
David Byun ◽  
Yoshimi Endo ◽  
Scott Wolfe ◽  
Steve Lee
Keyword(s):  
Ganglion Cyst ◽  
Weight Bearing ◽  
Retrospective Chart Review ◽  
Wrist Pain ◽  
Control Group ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study ◽  
Dorsal Ganglion

Background The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence Diagnostic, Level III.

scholarly journals Superficial Siderosis and Sudden Sensorineural Hearing Loss: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Kirsti S. V. Lee ◽  
Niranjan Sritharan ◽  
Allan Forrest
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Sensorineural Hearing Loss ◽  
Unusual Case ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Superficial Siderosis ◽  
Imaging Features ◽  
Delayed Complication ◽  
Magnetic Resonance Imaging Mri

This case report highlights an unusual case of sudden sensorineural hearing loss related to superficial siderosis (SS). Our patient had a craniotomy for medulloblastoma 23 years earlier, and this may represent a delayed complication related to this procedure. Magnetic resonance imaging (MRI) remains the key diagnostic investigation to illustrate the imaging features of superficial siderosis and exclude other pathologies. Increased awareness of progressive and sudden hearing complications caused by SS is important in the otolaryngologic community to expedite management and better counsel patients during the consent process.

Abstract T P312: Utility of Early MRI in Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sherri A Braksick ◽  
Sara Hocker
Keyword(s):  
Intracerebral Hemorrhage ◽  
Clinical Management ◽  
Older Patients ◽  
Sinus Thrombosis ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Amyloid Angiopathy ◽  
Non Invasive ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes

Introduction: Intracerebral hemorrhage (ICH) causes significant morbidity and mortality. Utility of early magnetic resonance imaging (MRI) is not fully understood. Identifying patients in whom early MRI changes clinical management may improve outcomes in select patients and reduce costs overall by avoiding inpatient MRIs in patients who are unlikely to benefit. Hypothesis: We assessed the hypothesis that early MRI in patients with spontaneous ICH does not alter management acutely in older patients. Methods: We conducted a retrospective chart review of all ICH admitted to our institution from 2006-2012. Patients were excluded if they 1) had a known underlying lesion, 2) were < 18 years, 3) suffered ICH as a result of trauma or 4) did not undergo MRI. Data were evaluated for clinical or radiographic characteristics that resulted in a change in clinical management, including surgical intervention or future avoidance of antithrombotic medications, among others. Results: In total, 248 patients with a median age of 70 years (IQR 58-78) were included. MRI changed management in 79 patients (31.9%). Initial MRI was obtained an average of 10 days after the hemorrhage. Possible structural abnormalities requiring emergent intervention were found in 14 (17.7%) patients, while 64 (81.0%) had findings concerning for other non-emergent/non-surgical anomalies (possible tumor (n=6), cavernoma (n=7), alternate diagnosis (n=1), probable amyloid angiopathy (n=21), evaluation for embolic phenomenon (n=13), evaluation for vasculitis (n=2), abnormal edema/enhancement (n=8), MRI led to additional non-invasive vascular imaging (n=6)). One patient (1.3%) was found to have a venous sinus thrombosis prompting anticoagulation. MRI was more likely to result in a change in management in patients < 55 years of age (47.1% vs 27.9%, p=0.009). Conclusions: MRI after ICH changed management in approximately one-third of patients and resulted in an immediate change in management in a minority of patients. Younger patients are more likely to benefit from early MRI. In older patients suspected of amyloid angiopathy that may preclude future antithrombotic therapy, delayed MRI in the outpatient setting may be reasonable.

Sudden hearing loss in intralabyrinthine haemorrhage in a child

2004 ◽  
Vol 118 (6) ◽  
pp. 450-452 ◽  
Author(s):  
Chul Ho Jang ◽  
Young Ho Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Unusual Case ◽  
Previous History ◽  
Sudden Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Bleeding Disorders ◽  
Resonance Imaging ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

This paper reports an unusual case in which aseptic meningitis presented with sudden sensorineural hearing loss (SSNHL) associated with intralabyrinthine haemorrhage (ILH). A seven-year-old girl presented with sudden right-sided hearing loss with dizziness. She did not have a previous history of bleeding disorders. This child was assessed using audiograms and magnetic resonance imaging (MRI). The patient's hearing loss was irreversible. Steroid therapy was not effective. SSNHL associated with ILH can be one of the negative prognostic factors in children.

scholarly journals The Role of Antioxidants in the Treatment of Congenital CMV-Related Hearing: A Case-Control Study

OTO Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 2473974X1984185 ◽  
Author(s):  
Hilary McCrary ◽  
Veronica del Calvo ◽  
Jeremy Purser ◽  
Geoff Casazza ◽  
Albert Park
Keyword(s):  
Hearing Loss ◽  
Case Control Study ◽  
Retrospective Chart Review ◽  
Case Control ◽  
Antioxidant Therapy ◽  
Hearing Thresholds ◽  
The Mean ◽  
The Right ◽  
Control Study

Objective Antioxidants have been used as a therapeutic measure for several causes of hearing loss, and this study aims to examine the use of antioxidants in children with congenital cytomegalovirus (cCMV)–related hearing loss. Study Design Case-control study. Setting Academic pediatric hospital. Subjects and Methods A retrospective chart review of pediatric patients with cCMV-related hearing loss treated with and without antioxidants (vitamins A, C, and E and magnesium, known as ACE-Mg) was completed. The primary end point was the mean change in hearing thresholds for the right and left ears after therapy. An evaluation of the mean change in thresholds was evaluated at the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. A 2-sample t test and multiple linear regression were used to evaluate the data. Results A total of 78 children with cCMV-related hearing loss were included in the study, of whom 10 were treated with antioxidants. The average amount of time in which antioxidants were taken was 387 days. When comparing cases and controls, there was no differences in the mean change of hearing thresholds at each frequency for both the right and left ears ( P > .05). Length of antioxidant therapy and age at which therapy was initiated had no effect on hearing scores ( P > .05). Conclusions Oxidative stress plays a role in the pathogenesis of cCMV-related hearing loss. ACE-Mg is a safe adjuvant therapy for the treatment of hearing loss in children; however, this study demonstrates no hearing-related benefit from ACE-Mg antioxidant therapy.

S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P146-P146
Author(s):  
Selena E. Heman-Ackah ◽  
Dunn Ryan ◽  
Tina C. Huang
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Diagnostic Evaluation ◽  
Diagnostic Screening ◽  
Tertiary Care Facility

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.

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