Presentation
Signs of raised intracranial pressure. A CT scan was performed (not shown) revealed an obstructive hydrocephalus with a mass at the left cerebellopontine angle. A VP shunt was inserted and an MRI was requested for characterization.
Patient Data
Large well-circumscribed extra-axial mass at the left cerebellopontine angle with no significant intracanalicular extension. It displays a low signal on T1 and, a heterogeneous high signal on T2 and FLAIR with no restricted diffusion. The postcontrast sequences show a heterogeneous enhancement with central cystic components.
Moderate surrounding vasogenic edema with a mass effect on the left middle cerebellar peduncle, brainstem, and the cisternal portion of the trigeminal nerve as well as the cerebellar hemisphere and 4th ventricle which is compressed and displaced to the right with tonsillar herniation.
Normal functioning of the VP shunt.
Case Discussion
MRI features most consistent with acoustic neuroma of left CPA compressing the middle cerebellar peduncle, brainstem, cerebellar hemisphere, cisternal portion of the trigeminal nerve, and 4th ventricle with secondary obstructive hydrocephalus (shunted).
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