Vestibular Schwannoma: An Occasional Diagnosis during an Occasional Examination

Abstract

Introduction : Vestibular schwannoma (VS) is a rare and benign tumor originating from Schwann cells of the vestibular component of the eighth cranial nerve, which tends to give only late clinical manifestations. In general its diagnosis is late or occasional. Case : We present the case of a 56-year-old woman who complained for difficult nasal breathing. It seemed to be a simple case of congestion of nasal turbinates , but during clinical interview, a spontaneous nystagmus beating to the right was noted. Continuing medical history, the patient reported an annoying right hearing loss and a slight dizziness which lasted from about 1 month. So we performed an audiometric examination and a CT scan. Finally MRI with gadolinium showed an expansive lesion of the right cerebellopontine angle with intra-extrameatal development, of 28 mm, and a large cystic intralesional component, compatible with an eighth cranial nerve VS. The VS was macroscopically removed with surgery. Discussion : We explain an occasionally diagnosed case of VS. Although gold standard for its diagnosis is MRI, history and physical examination should always be as complete and thorough as possible, even when we are dealing with patients so-called “non-patients”. We say how we perform a vestibular visit and we make a review of recent literature, with the intention of providing basic information on how to treat a dizzy patient. Conclusion : We want to emphasize the concept of never forget the VS, among the many causes of vertigo, and the importance for its diagnosis covered by history and physical examination .