Carcinoma epidermoide en senos paranasales con epistaxis / Epidermoid carcinoma in paranasal sinuses with epistaxis pretends vestibular schwannoma

El carcinoma epidermoide es un tumor maligno, infiltrante y destructor, que origina metástasis por vía linfática, hemática e invasión directa; en la zona nasosinusal es relativamente poco frecuente. Objetivo: identificar las características clínicas de esta patología para el correcto abordaje y tratamiento. Presentación de caso clínico: paciente femenina con carcinoma epidermoide en senos paranasales, 36 años, procedente de Villa de San Antonio, Honduras. En febrero de 2016 acude al Hospital Colonial de Comayagua por una obstrucción nasal derecha, concomitante epistaxis recurrente con coágulos del lado derecho. Posteriormente se presentaron dos episodios graves de epistaxis; después es referida a la Consulta Externa del Hospital Escuela Universitario, donde se encontró a la exploración física: órbita inflamada del ojo derecho, acompañada de pérdida de la sensibilidad superficial y profunda del lado derecho de la cara. Se realizó estudio histopatológico, que reportó tejido conectivo infiltrado por nidos neoplásicos con características malignas, formando agregados con apariencia epitelial. Se diagnosticó carcinoma epidermoide en fosa nasal derecha y región pterigomaxilar. Finalizados los procedimientos quirúrgicos recibió a 37 días de radioterapia profiláctica, con control posterior en oncología del Hospital General San Felipe. Conclusión: ante un paciente que presenta sangrado nasal constante con obstrucción, lagrimeo y una masa en senos paranasales, se debe sospechar de una patología neoplásica de acuerdo a los tipos más frecuentes en el área anatómica de origen; por lo tanto, una vez identificado, se debe realizar biopsia y marcadores tumorales para establecer de forma oportuna diagnóstico, pronóstico, presencia de metástasis y el tratamiento a seguir.

Role of cervical vestibular evoked myogenic potentials (cVEMP) and auditory brainstem response (ABR) in the evaluation of vestibular schwannoma / Papel dos potenciais evocados miogênicos vestibulares cervicais (cVEMP) e potencial evocado auditivo de tronco encefálico (PEATE) na avaliação do schwannoma vestibular

Abstract Introduction: Cervical vestibular evoked myogenic potentials (cVEMP) can assess the integrity of the inferior vestibular nerve thereby promising to be a useful tool in the audiological test battery to diagnose vestibular schwannoma. Objective: To ascertain the utility of cVEMP in diagnosis of vestibular schwannoma in conjunction with the ABR and to evaluate whether the size of lesion has any effect on the cVEMP measures. Methods: Case-files of 15 known cases of vestibular schwannoma whose pure tone audiometry, auditory brainstem response (ABR), cVEMP and radiological investigation findings were available, were included in the study. Patients were categorised as large or small tumours based on the size. The absolute and inter-peak latencies of ABR, amplitudes of waves V and I, and inter-aural latency difference of wave V of ABR; and latency of P1 and N1 of cVEMP and amplitude of P1-N1 complex were considered in the study. Results: There were eight large and nine small tumours. All the patients with large tumours showed significant severity of hearing loss whereas only three out of nine patients with small tumours showed severe to profound deafness in the affected ear. The rest showed hearing status ranging from normal hearing sensitivity to moderate hearing loss. Most of the patients with large tumours showed complete absence of ABR in the affected ears with no identifiable wave-peaks. ABR in small tumours exhibited delayed III-I and delayed V-I interpeak latency interval (IPL). Four out of five patients with large unilateral tumours revealed contralateral effects of reduced amplitude or absence of cVEMP. On the contrary, six out of eight unilateral small tumours showed a normal cVEMP response in the contralateral ear. Both the patients with NF2 in the present study demonstrated cVEMP abnormalities. Conclusion: ABR and cVEMP, when used in combination, can be of immense use in identification of neuro-otologic conditions such as vestibular schwannoma and bilateral tumours in NF2. In the evaluation of unilateral vestibular schwannoma, abnormal contralateral findings of cVEMP and ABR are strongly indicative of the tumour size >2.5 cm. In unilateral severe to profound loss wherein ABR in poorer ear cannot give information of site-of-lesion, cVEMP can help in the differentiation.

Resumo Introdução: Os potenciais evocados miogênicos vestibulares cervicais (cVEMP) podem avaliar a integridade do nervo vestibular inferior, prometem assim ser uma ferramenta útil na bateria de testes audiológicos para o diagnóstico de schwannoma vestibular. Objetivo: Determinar a utilidade de cVEMP no diagnóstico de schwannoma vestibular em conjunto com PEATE e avaliar se o tamanho da lesão tem qualquer efeito sobre as medidas do cVEMP. Método: Quinze casos diagnosticados com schwannoma vestibular cujos exames de audiometria tonal pura, potencial evocado auditivo de tronco encefálico (PEATE), cVEMP e investigação radiológica estavam disponíveis foram incluídos no estudo. Os pacientes foram classificados como portadores de tumores grandes ou pequenos. As latências absolutas e interpico de PEATE as amplitudes das ondas V e I e a diferença de latência interaural da onda V da PEATE e a latência de P1 e N1 de cVEMP e amplitude do complexo P1-N1 foram consideradas no estudo. Resultados: Havia oito tumores grandes e nove pequenos. Todos os pacientes com tumores grandes apresentavam perda auditiva grave enquanto apenas três dos nove pacientes com pequenos tumores apresentaram surdez grave a profunda na orelha acometida. O restante apresentou audição que variou de normal a perda auditiva moderada. A maioria dos pacientes com tumores grandes demonstrou ausência completa de PEATE nas orelhas acometidas sem picos de onda identificáveis. O PEATE em tumores pequenos apresentou intervalo de latência interpico (ILI) tardia III-I e tardia V-I. Quatro em cada cinco pacientes com tumores grandes unilaterais revelaram efeitos contralaterais de amplitude reduzida ou ausência de cVEMP. Ao contrário, seis dos oito tumores pequenos unilaterais apresentaram resposta de cVEMP normal na orelha contralateral. Ambos os pacientes com NF2 no presente estudo demonstraram anormalidades na cVEMP. Conclusão: PEATE e cVEMP, quando usadas em combinação, podem ser úteis na identificação de condições neuro-otológicas como schwannoma vestibular e tumores bilaterais em NF2. Na avaliação de schwannoma vestibular unilateral, achados contralaterais anormais de cVEMP e PEATE são fortemente indicativos de tumor >2,5 cm. Na perda unilateral grave a profunda, na qual o PEATE na orelha mais prejudicada não fornece informações do local da lesão, cVEMP pode ajudar na diferenciação.

Schwanoma gigante do VIII nervo craniano de evolução subaguda: relato de caso / Subacute evolution of giant schwannoma of VIII cranial nerve: case report

O schwanoma vestibular é uma neoplasia que se origina das células de Schwann da porção vestibular do VIII nervo craniano e que corres- ponde a cerca de 10% dos tumores intracranianos e a 80% a 90% daqueles localizados no ângulo pontocerebelar. Apesar do crescimento lento e evolução em geral benigna, estes tumores podem evoluir de maneira desfavorável devido à localização em compartimento anatômico relativamente reduzido no crânio (fossa posterior), o que pode levar a compressão de estruturas nobres (como o tronco encefálico) e a desenvolvimento de hidrocefalia obstrutiva, especialmente nos raros casos de schawanomas gigantes (> 40 mm). Apresentamos relato de caso de paciente com quadro de tinnitus e hipoacusia à esquerda que evoluiu de forma subaguda com alterações do humor, da cognição e da marcha cujo diagnóstico final foi de schwanoma gigante do VIII nervo craniano.

Vestibular schwannoma is a Schwann cells neoplasia of the vestibular branch of the VIII cranial nerve and it accounts for 10% of intracranial tumours and to 80%-90% of those located at the cerebellopontine angle. Despite slow growth and usual benign evolution, unfavourable outcomes may occur, especially in the rare cases of giant schwanno- mas (> 40mm). Owing the fact that this tumours are located in a relatively narrow space (posterior fossa), giant schwannomas may compress noble areas (as the brainstem), which can also cause obstructive hydrocephalus. We discuss a case report of a 48 years old woman complaining of left-sided hearing loss and tinnitus that developed a subacute cognitive impairment, mood disorder and gait disturbance, diagnosed with giant schwannoma of the VIII nerve.

Evaluación del Video Head Impulse Test (V-Hit) en el diagnóstico del neurinoma del acústico / Evaluation of video Head Impulse Test (v-HIT) in the diagnosis of acoustic neuroma

Introducción: La gran mayoría de lesiones que comprometen el conducto auditivo interno corresponden a schwannomas vestibulares (90%). Dentro de las nuevas pruebas diagnósticas del sistema vestibular aparece la prueba de impulso cefálico y su registro con el video Head Impulse Test (v-HIT) que permite el estudio de todos los canales semicirculares. Objetivo: Comparar el v-HIT para canales semicirculares laterales con las pruebas calóricas clásicas registradas mediante videonistagmografía en el comportamiento de los neurinomas intracanaliculares y evaluar su utilidad como test diagnóstico. Material y método: Dieciocho pacientes fueron reclutados con diagnóstico de neurinomas, confirmado mediante resonancia magnética y estudios con pruebas calóricas clásicas y v-HIT para canal horizontal. Resultados: Los resultados anormales de asimetría de ganancia y de sacadas correctivas fue de 13 pacientes (72%) y con hipoexcitabilidad en la prueba calórica fue de 9 pacientes (50%), con una sensibilidad de la prueba de 72% para vHIT y de 50% para la prueba calórica al compararlo con la resonancia magnética. Conclusión: El v-HIT es una herramienta complementaria a las pruebas calóricas y debe ser incluida como test diagnóstico dentro de la batería de exámenes para evaluar el sistema vestibular en forma completa mediante un vestibulograma.

Introduction: The majority of injuries involving the internal auditory canal correspond to vestibular schwannomas (90%). Within the new diagnostic tests for the vestibular system appears the Head Impulse test and the video head impulse test (v-HIT) which allows the studying of all the semicircular canals. Aim: Compare the v-HIT lateral semicircular canals with classical caloric tests recorded by videonistagmography (VNG) in the behavior of intracanalicular neuroma and evaluate its usefulness as a diagnostic test. Material and method: Eigtheen patients were enrolled with a diagnosis of schwannomas, confirmed by MRI and studied classical caloric tests and v-HIT for horizontal channel. Results: Abnormal results of asymmetry gain and corrective saccades was 13 patients (72%) and hypoexcitability in the caloric test was 9 patients (50%), with a test sensitivity of 72% for vHIT and 50% for caloric test compared with MRI. Conclusions: The v-HIT is a complementary tool to caloric tests and should be included as a diagnostic test within the battery of tests to evaluate the vestibular system in complete form by vestibulogram.

Role of magnetic resonance imaging in evaluation of cerebellopontine angle tumors

Objective: to determine the role of MRI in evaluation of different Cerebellopontine angle tumors, and differentiation between them

Materials and Method: This study was conducted in the period between January 2009 and December 2012. Fifty four patients with CPA masses were selected on bases of neurotological complains that related to CPA

Results: Cerebellopontine angle masses in this study were classified into two groups: acoustic neuromas and non acoustic neuromas CPA masses. Twenty eight of cases [51.8%] were acoustic neuromas in which 26 cases were unilateral acoustic neuromas and 2 cases with bilateral neuromas, the remaining 26 cases [48.2%] were other non acoustic CPA masses. These included, one trigeminal neuroma [1.9%], 6 [11.1%] cases were CPA meningiomas, 6 [11.1] cases were epidermoid, 3 [5.6%] cases were arachnoid cyst, 2 [3.7%] cases were glomus jugulare tumors, 3 [5.6%] cases metastatic tumors and 5 [9.2%] cases were intraaxial and intraventricular tumors extending to the CPA, this included 2 cases cerebellar hemangioblastoma, 1 case pontine glioma and 2 cases were fourth ventricular ependymoma

Conclusion: MR imaging is considered the imaging method of choice to assess CPA tumors and to distinguish between them

Atypical Manifestation of Vestibular Schwannoma

Vestibular schwannoma (also known as acoustic neuroma) is a benign tumor whose cells are derived from Schwann sheaths, which commonly occurs from the vestibular portion of the eighth cranial nerve. Furthermore, vestibular schwannomas account for ∼8% of intracranial tumors in adults and 80 to 90% of tumors of the cerebellopontine angle. Its symptoms are varied, but what stands out most is a unilateral sensorineural hearing loss, with a low index of speech recognition. Objective: Describe an atypical manifestation of vestibular schwannoma. Case Report: The 46-year-old woman had vertigo and binaural hearing loss and fullness, with ear, nose, and throat examination suggestive of cochlear injury. After 6 months, the patient developed worsening of symptoms and onset of right unilateral tinnitus. In further exams the signs of cochlear damage remained, except for the vestibular test (hyporeflexia). Magnetic resonance imaging showed an expansive lesion in the right cerebellopontine angle. Discussion: This report warns about the atypical manifestations of vestibular schwannoma, which must always be remembered in investigating and diagnosing hearing loss...

Shwannoma unilateral do acústico em criança sem associação com neurofibromatose / Unilateral acoustic schwannoma in child without neurofibromatosis

Schwannomas do acústico representam 8% dos tumores intracranianos primários do adulto, havendo apenas 20 casos relatados em crianças sem associação com neurofibromatose. Aqueles que ocorrem em crianças geralmente são ricamente vascularizados, sendo preconizada por alguns autores a embolização da lesão antes da cirurgia. Relata-se e discute-se o terceiro caso da literatura nacional de schwannoma do acústico em uma criança sem associação com neurofibromatose. Paciente feminina, de 10 anos, apresentando ataxia, cefaleia e diminuição da acuidade auditiva à direita. A ressonância magnética (RM) mostrou massa tumoral no ângulo pontocerebelar direito sugestiva de meduloblastoma/ependimoma. A análise histopatológica do espécime cirúrgico fez o diagnóstico de schwannoma do acústico. Na investigação clínica, a criança não apresentava neurofibromatose. Embora seja raro em crianças sem associação com neurofibromatose, a hipótese de schwannoma não deve ser descartada em casos de diminuição da acuidade auditiva com RM demonstrando massa tumoral no ângulo pontocerebelar.

Acoustic schwannomas account for 8% of primary adult intracranial tumors, and there are only 20 cases reported in children without neurofibromatosis. These tumors are extremely vascular in children, and some authors recommend a preoperative angiographic embolization. We report and discuss the third case of the national literature of an acoustic schwannoma in a child without neurofibromatosis. 10 year-old female, with ataxia, headache and deafness in the right ear. Magnetic resonance imaging (MRI) revealed a tumor mass in the right cerebellopontine angle suggestive of medulloblastoma/ependimoma. The histopathological analyses diagnosed an acoustic schwannoma. None clinical evidence of neurofibromatosis was seen. Although schwannoma is rare in children without neurofibromatosis, this hypothesis can not be dismissing in patients with deafness and MRI reveling tumor mass in the cerebellopontine angle.

Hipoacusia súbita? / Sudden hearing loss?

Se presenta un caso de paciente mujer sin antecedentes mórbidos que consulta a nuestro servicio por síntomas sugerentes de hipoacusia súbita. La evaluación audiométrica y prueba calórica era compatible con una parálisis cocleovestibular y dado que no presentaba contraindicaciones, se decide iniciar tratamiento con corticoides y antiviral oral. La evolución inicial fue favorable sin embargo al control del mes presentó un nuevo deterioro audiométrico. Esto motivó mayor estudio con el cual se pudo llegara un diagnóstico etiológico. Este caso es presentado para recordar que hay otras patologías que pueden simular una hipoacusia súbita idiopática, lo cual no se debe olvidaren el manejo de estos pacientes.

Clinical case of female patient without morbid background who consults due to sudden hearing loss symptoms. The audiometric and caloric tests were compatible with a cochleo vestibular paralysis and because there were no contraindications, oral steroids and antiviral, treatment was indicated. Although the initial response was favorable, at the first month check up an audiometric deterioration was found. This led to further study achieving an etiological diagnosis. This case is presented to remind that there are other pathologies that can simulate an idiopathic sudden hearing loss, which should not be forgotten in the management of these patients.

Schwannoma de forame jugular: relato de caso / Jugular foramen schwannoma: case report

Introdução: As lesões do forame jugular são raras, sendo os paragangliomas os tumores mais comuns desta região seguidos pelos schwannomas. Os schwannomas são tumores benignos de crescimento lento e origem principalmente nos nervos cranianos sensitivos. Quando localizados no forame jugular, apresentam-se clinicamente com perda auditiva, ataxia e cefaleia, sendo comuns as alterações dos nervos cranianos IX, X e XI. A excisão cirúrgica é a opção terapêutica de escolha. Relato do Caso: Relatamos o caso de um paciente adulto jovem que procurou o serviço de Otorrinolaringologia do Hospital Universitário de Brasília com quadro de otalgia e otorreia piossanguinolenta no ouvido esquerdo, associada a zumbido, hipoacusia e tumor no conduto auditivo externo. Iniciada investigação diagnóstica com tomografia computadorizada e biópsia, ambas com resultados inconclusivos. Realizadas então nova biópsia e ressonância nuclear magnética, com diagnóstico definitivo de schwannoma do foram jugular. Na ocasião a lesão foi definida como tipo D pela classificação de Kaye-Pellet, por envolver o forame jugular, apresentar formato de halter e componentes intra e extracraniano. Realizada cirurgia por craniotomia com excisão parcial do tumor. Não houve sequelas do procedimento, apesar da persistência dos sintomas otológicos. Comentários Finais: O caso é um exemplo de uma doença rara, com pouco mais de duzentos casos relatados na literatura, e apresentação clínica incomum. O desafio diagnóstico e terapêutico é enfrentado pelas equipes de Otorrinolaringologia e Neurocirurgia, que programam para breve nova abordagem cirúrgica combinada para extirpação completa do tumor.

Introduction: Lesions of the jugular foramen are uncommon, and the paragangliomas are the most common tumors in this region, followed by schwannomas. Schwannomas are benign tumors, of slow growth and origin mainly in the sensitive cranial nerves. When located in the jugular foramen, the patients present with clinically auditory hearing loss, ataxia and headache, and cranial nerves IX, X and XI alterations are also common. Surgical excision is the therapeutic choice. Case Report: We reported the case of a young adult patient who sought the Otorhinolaryngology service at the School Hospital of Brasília for investigation of otalgia and chronic infection in the left ear, associated with tinnitus, hypacusis and tumor in the external ear canal. Initial diagnostic investigation by computed tomography and biopsy was inconclusive. New biopsy and magnetic resonance imaging were performed and definitive diagnosis of jugular foramen schwannoma was given. The lesion was then defined as type D by the classification of Kaye-Pellet, for it involved the jugular foramen, presented format of dumbbell and intra and extracranial components. The patient underwent a craniotomy and partial excision of the tumor. He did not have sequels of the procedure, although the otologic symptoms persisted. Final Comments: This case is an example of a rare disease. No more than two hundred cases have been reported in the literature and the clinical presentation is uncommon. The diagnostic and therapeutic challenge is faced by Otorhinolaryngology and Neurosurgery teams who are scheduling a new combined surgical procedure for a complete excision of the tumor.

Neurinoma del acústico diagnosticado durante el embarazo: reporte de un caso / Acoustic neurinoma during pregnancy: a case report

Los tumores cerebrales son infrecuentes durante el embarazo. Los neurinomas del acústico pueden ser sintomáticos por primera vez durante la gestación y representan el 6-8 por ciento de las neoplasias intracraneales. El objetivo de esta comunicación es presentar el caso de una primigesta adolescente que presentó sintomatología neurológica de afectación del VIII par y de fosa posterior, característica de la neurofibromatosis tipo 2.

Brain tumors are infrequent during pregnancy. Neurinomas of auditive nerve can get to be symptomatic during gestation, representing 6-8 percent of the intracranial neoplasias. The objective is to report a case of a pregnant adolescent who present a neurological symptoms of VIII pair affectation and posterior cranial fossa, characteristic of the neurofibromatosis type 2.

Neurinoma del acústico (schwanoma vestibular): revisión y actualización de la literatura: [revisión] / Acoustic neuroma (vestibular schwannoma): a literature review: [revision]

El neurinoma del acústico corresponde al tumor más frecuente del ángulo pontocerebeloso. En su etiopatogenia se involucran factores genéticos que permiten su aparición, estando en algunos casos ligados a enfermedades como la neurofibromatosis tipo 2 expresándose de manera bilateral. Clínicamente se divide en 4 estadios que desencadenan una diversa gama sintomatológica de acuerdo al grado de compresión y ocupación del conducto auditivo interno y tronco encefálico, sin embargo la hipoacusia sigue siendo el síntoma más importante en su presentación. Estos son el estadio intracanalicular, cisternal, de compresión de tronco encefálico e hidrocefálico. Habitualmente alcanzan un tamaño que fluctúa entre los pocos milímetros hasta más de 3 centímetros de diámetro dividiéndose en pequeños, medianos y grandes. Asimismo se ha dicho que poseen un lento crecimiento e historia natural incierta mostrando la mayoría de los estudios cifras de crecimiento entre los 1-3 mm/año. Para la orientación diagnóstica la audiometría de tonos puros sigue siendo el examen más orientador en una primera etapa, sin embargo el estudio imagenológico con resonancia magnética contrastada con gadolinio resulta fundamental para la confirmación en la actualidad. En lo que al manejo respecta existen 3 alternativas razonables dependiendo del caso en particular como son la conducta expectante, la microcirugía y la radioterapia estereotáxica o Gamma Knife. Cada una de ellas posee factores a favor como en contra, por lo que la decisión terapéutica final se tomará considerando la velocidad de crecimiento, el tamaño tumoraly sintomatología siendo fundamental las prioridades del paciente.

Acoustic neuroma is the most frequent ponto cerebellar angle tumor. Genetic factors are involved in its etiology and in occasions its origins can be linked to diseases such as bilaterally expressing type 2-neurofibromatosis. Clinically acoustic neuromas can be classified in 4 stages, which result in diverse symptoms, according to the degree of brain stem and internal auditory canal compression or obstruction; however, hearing loss remains as the most important presenting symptom. The four stages are: intracanalicular, cisternal, brain stem compressive and hydrocephalic. Frequently they reach between few millimeters to more than 3 centimeters in diameter, and are accordingly ranked as small, medium-sized, and large. They have been reponed as having slow growth and uncertain natural history; in most studies growth rafes fluctuate between 1-3 mm/year Pure tone audiometry is the procedure of chote for diagnosis orientation in the first place, however, gadolinium-contrasted magnetic resonance imaging is currently pivotal for diagnosis confirmation. As for management, there are three reasonable alternatives, depending on a given case particularity. These are monitoring, microsurgery and stereotactic radiotherapy or gamma knife. Each one of them has its pros and cons, and thus the final therapy decisión will depend on the symptoms and tumor growth rate andsize, príorizlng thepatient well-being.

Tumor do VIII nervo com apresentação incomum / An uncommon presentation of an VIII nerve tumor

Os Schwannomas vestibulares são responsáveis por 80 a 90 por cento dos tumores do ângulo ponto-cerebelar. A atual incidência é estimada em 0,8 por cento a 2,5 por cento da população mundial. A hipoacusia unilateral e progressiva é o sintoma mais precoce e freqüente, sendo o tinido a segunda queixa mais comum. Estudos demonstram que apenas 5 por cento dos pacientes com schwannoma vestibular têm exames audiométricos normais. No caso em foco é relatado hipoestesia da hemiface com diminuição do reflexo córneo palpebral ipsilateral, hipoestesia da porção póstero-superior do pavilhão auditivo (sinal de Hitzelberger positivo), diminuição do lacrimejamento, Romberg sensibilizado positivo. Observava-se discreto desvio da rima labial para a esquerda, não apresentando outras alterações nos demais pares cranianos. À acumetria, não havia alteração da sensibilidade auditiva em ambas as vias aéreas.

Vestibular Shwannomas are responsible for 80-90 percent of the cerebelar-pontine angle tumors and their incidence is of 0.8 to 20.5 percent of all tumors. Unilateral and progressive hearing loss is the most frequent and premature symptom, and tinnitus is the second most common complaint. Only 5 percent of the patients have normal audiograms. In this case the patient complained of ipsilateral facial numbness and weak blink, posterior pinna hypoesthesia (Hitzelberger +), tear reduction and positive Romberg test. He also had mouth twisting but no other involvement of other cranial nerves. Hearing acuity was normal.

Cystic acoustic schwannoma: a case report and review of literature

A cystic acoustic neurinoma almost entirely consists of a cystic component and is a well recognized subtype of acoustic schwannoma. We report a case of a 40-yearold male patient who presented with clinical features of a left cerebello-pontine angle mass lesion and CT scan findings mimicking the diagnosis of an epidermoid cyst. However intraoperative and histopathological findings were suggestive of a large cystic acoustic schwannoma. We have also analyzed the characteristics, clinical symptoms and radiological findings of these tumors. In the presence of a large cystic cerebellopontine angle tumor without a significant hearing loss and no destruction of the internal auditory canal, the possibility of the cystic acoustic neurinoma should be considered

Surdez súbita unilateral como manifestação de schwannoma vestibular: relato de caso / Sudden deafness as a presenting symptom of acoustic neuroma: case report

O schwannoma vestibular, também conhecido como neuroma ou neurinoma do acústico, é o tumor mais freqüente do ângulo pontocerebelar correspondendo a aproximadamente a 9 por cento de todos os tumores intracranianos. APRESENTAÇÃO DO CASO: Os autores apresentam um relato de caso de surdez súbita e zumbido unilateral com melhora dos sintomas através de tratamento clínico com Prednisona e Pentoxifilina e posterior diagnóstico por exame de imagem de schwannoma vestibular. DISCUSSÃO: A surdez súbita pode ser descrita como uma perda neurossensorial abrupta e intensa. Costuma ser acima de 30 dB, em três ou mais freqüências contíguas e se desenvolve em menos de três dias. CONCLUSÃO: É de grande importância a pesquisa da etiologia nos casos de surdez súbita para a boa condução do caso e orientação terapêutica.

Vestibular schwannoma, also known as acoustic neurinoma, is the most frequent tumor of the cerebellopontine angle, and represents 9 percent of all intracranial tumors. CASE REPORT: The authors report a case of sudden deafness with unilateral tinnitus. The patients responded to therapy with Prednisone and Pentoxifylline after the diagnosis of acoustic neurinoma by imaging exams. DISCUSSION: Sudden deafness can be described as an intense and abrupt sensorineural loss. Usually it is higher than 30 dB at three or more frequencies and develops in less than three days. CONCLUSION: Investigation of the etiology of sudden deafness is extremely important to establish the adequate strategy for the case.

Experiencia en sospecha y diagnóstico del neurinoma del acústico / Experience in suspicion and diagnosis of neurinoma of the acousticol

El presente trabajo revisa los hallazgos clínicos, audiométricos, funcionales de VIII par e imagenológicos de una serie consecutiva de 10 pacientes con neurinoma del acústico.En el 50 por ciento de los pacientes se presentó con síntomas atípicos como la sordera súbita o la hipoacusia fluctuante. En el 100 por ciento de los casos existía algún compromiso de la audición; sin embargo, no hubo correlación entre el tamaño del tumor y la cuantía de la pérdida auditiva. El tipo de curva en la audiometría o la alteración de las pruebas supraliminares (discriminación de la palabra, Fowler, umbral de molestia auditiva y deterioro tonal) no permitieron predecir la presencia de un neurinoma. La alteración del reflejo acústico fue la prueba no imagenológica que obtuvo la mayor sensibilidad (80 por ciento). Se observó una asimetría en la prueba calórica sólo en un 40 por ciento de los casos. Se puede concluir que la presentación clínica considerada como típica del neurinoma del acústico, los exámenes no imagenológicos tienen un rol muy limitado. La baja sensibilidad de las pruebas funcionales del VIII par reportada en la literatura y confirmada en esta serie de pacientes debe inducirnos a solicitar estudio con neuroimágenes en todos aquellos casos en los que exista una sospecha clínica. La resonancia nuclear magnética (RNM) con gadolinio fue el examen más idóneo para ello, ya que permitió hacer el diagnóstico en 2 casos en que la tomografía computada (TC) sólo fue de presunción, y en un tercer paciente reveló un tamaño tumoral significativamente mayor al observado en la TC.

Correlation of CT scan and histopathology in brain tumours

The objective of this study was to determine the preoperative diagnostic accuracy of CT Scan in brain tumours and compare it with post operative histopathology results. This study was conducted at PNS Shifa Naval Hospital Karachi over a period of four years from December 1995 to December 1999. A total of 100 patients were included who underwent computed tomography [CT] scan for suspected brain tumours. Selection criteria included those single intracranial masses labeled as brain tumour on the basis of their CT features. Multiple lesions were excluded. The patients' age ranged from 13 85 years, mean age 43 years with male to female ratio 2:1 The common clinical presentations were headache, diplopia, seizures, personality changes, vertigo, vomiting and progressive neurological deficit. The results of our study revealed that out of hundred cases gliomas were 48, meningiomas 25, pituitary adenomas 12, craniopharyngiomas 6, pineal region tumours 4, acoustic neuromas 3 and choroid plexus papilloma 2. The diagnostic accuracy of CT scan was found to be 8396 on average, when correlated with histopathology