Presentation
Right hearing loss with bilateral papilledema grade 2.
Patient Data
Well-defined extra-axial solid mass at the right cerebellopontine angle enlarging the ipsilateral porus acusticus with intracanalicular extension. It elicits a low signal on T1, heterogeneous high signal intensity on T2 and FLAIR with heterogeneous enhancement and central necrosis on postcontrast sequences. A mass effect is noted on the brainstem, right middle cerebellar peduncle, a cisternal portion of the trigeminal nerve as well as the cerebellar hemisphere and 4th ventricle which is laminated and displaced to the left.
Moderate dilatation of the 3rd and lateral ventricles, indicating obstructive hydrocephalus.
Vertical tortuosity of the optic nerves with enlargement of the subarachnoid space around the optic nerves and flattening of the posterior sclera bilaterally indicating intracranial hypertension.
A pituitary microadenoma (4 mm) is noted (incidental finding).
Case Discussion
MRI features of a right acoustic neuroma grade 4 according to Koos grading scale with intracanalicular extension, compressing the adjacent structures with obstructive hydrocephalus and signs of secondary intracranial hypertension.
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