Presentation
Chronic headaches with vertigo.
Patient Data
Well-defined extra-axial mass at the right cerebellopontine angle obstructing the porus acusticus with mild intracanalicular extension. It displays a low signal on T1, heterogeneous high signal on T2 and FLAIR with vivid heterogeneous enhancement on postcontrast sequences. A mild mass effect is noted on the right middle cerebellar peduncle and brainstem.
Dilatation of the ventricular system (third and lateral ventricles) with increased Evans index (0.43) and acute callosal angle (68°) as well as disproportionate enlargement of the subarachnoid space with enlarged Sylvian fissures and narrow sulci and subarachnoid spaces at the vertex and parafalcine region
Patchy FLAIR and T2 hyperintensities periventricular the white matter, subcortical region and centra semiovale suggestive chronic small vessel ischemic change.
Annotate images:
Evans index = 0.43
callosal angle = 68°
Case Discussion
MRI features most consistent with CPA acoustic neuroma in a patient with a normal pressure hydrocephalus with chronic small vessel ischemic disease.