Presentation
Right hearing loss with vertigo.
Patient Data
Large, well-defined lobulated extra-axial solid-cystic mass at the right cerebellopontine angle enlarging the porus acusticus with intracanalicular extension. The solid component appears iso-to-hypointense on T1, heterogeneous high signal on T2 and FLAIR with heterogeneous enhancement on the postcontrast sequences. The cyst components are of low signal on T1 and FLAIR and high signal on T2 with a peripheral rim enhancement of the largest lesion.
A mass effect is noted on the right middle cerebellar peduncle, brainstem, cerebellar hemisphere and the ipsilateral cisternal portion of the trigeminal nerve. The 4th ventricle is compressed and displaced to the left with dilatation of the 3rd and lateral ventricles and tranependymal edema in keeping with obstructive hydrocephalus.
Case Discussion
MRI features most consistent with acoustic neuroma of right CPA with intracanalicular extension, compressing the middle cerebellar peduncle, brainstem, cerebellar hemisphere, cisternal portion of the trigeminal nerve, and 4th ventricle with secondary obstructive hydrocephalus.
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