Concluded Case

Vestibular Schwannoma with hemorrhage left CP angle .

New case 38 yr,M, Attended the OPD on 16th OCt with intermittent vertigo with occassional left temporal head ache since 3 months. On 15 th oct while climbing down the stairs after his office work he developed mild subjective vertigo with weakness of Rt lower limb ,his foot wear fell down and was unable to put it back. He sat down in the stair. Immediately felt numbness in the rt leg and he scratched the leg ,unable appreciate the sensation . With in 20 mts he regained the leg power, the numbness disappeared,he drew the vehicle and arrived home safely. The vertigo was subjective with out nausia or vomiting ,each episode for less than 30 mts. He used to get 2-3 episodes in a month. Occ non throbbing transient left temporal head ache also. 8 yrs ago he had developed left sided LNN facial palsy,treated by the Neurologist ,partially recovered. 3 yrs ago aggravation of already existing left facial weakness evaluated bythe same Neurologist.Since then he is having progressive hearing loss on the Lt ear,CT brain was done reported as normal. On exam vitals stable. BP 130/ 80 mmhg. Horizontal gaze evoked nystagmus fast component to left. 5th nerve normal .LMN partial 7th and sensoryneural deafness left side. Intact other cranial nerves.Motor system gr5/ 5 power. DTRS equal with downgoing plantars andintact sensations.Normal random walking and tandom walking showed mild unstediness. Patient is transferred to Neurosurgeon . Diagnosis and management?

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Concluded answer

Thanks Curofy and others. MRI shows relatively well defind extra- axial lesion with intratumoral hemorrhage and heterogeneous contrast enhancement of the left CP angle causing expansion of the cisternal space and laterally causing widening of the virus acoustics internus and small intracanalicular extension in to the left internal auditory canal. Surgery done. patient is better Imp : Vestibular Schwannoma

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Thanks Curofy and others. MRI shows relatively well defind extra- axial lesion with intratumoral hemorrhage and heterogeneous contrast enhancement of the left CP angle causing expansion of the cisternal space and laterally causing widening of the virus acoustics internus and small intracanalicular extension in to the left internal auditory canal. Surgery done. patient is better Imp : Vestibular Schwannoma

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Thanks Curofy
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Left cp angle mass with compression effect to near by structure T1 hypo with T2 hyper intensity with central hypodensity s/o necrosis High grade mitotic lesion. As per location most common CP angle mass is Vestibular schwanoma, meningioma from sphenoid sinus,

Cp angle tumor vestibular shwanoma.

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Surgery if the progression of symptoms more. Less than 3mm gamma knife

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Nice clip

Thank you doctor
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CP angle tumor

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