A Trigeminal Schwannoma Masked by Solely Vestibulocochlear Symptoms

Abstract

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 />