Presentation
Left-sided face numbness, tingling, progressive headache, visual disturbance, and unsteady gait.
Patient Data
There is a large well-defined dumbbell-shaped extra-axial left posterior fossa SOL. It measures about 50x30x30 mm along its maximum anteroposterior, transverse and craniocaudal dimensions respectively. It exhibits heterogeneous low T1 and high T2 and FLAIR signal intensities with small cystic areas as well as heterogenous post-contrast enhancement. it shows facilitated diffusion at DWI, It exerts a significant mass effect in the form of compression of the left side of the brain stem, left cerebellar peduncle, and ventral aspect of the left cerebellar hemisphere as well as the left anterior and inferior temporal lobe. It is compressing the 4th ventricle and cerebral aqueduct with mild supra-tentorial hydrocephalus
No sizable extension was seen within the left internal auditory canal.
Small frontal horn right lateral ventricle small intraventricular/subependymal few nodules are noted.
Partial empty sella is also noted.
Case Discussion
Left posterior fossa dumbbell-shaped extra-axial SOL with enhancement pattern, mass effect, relations, and extensions as described are worrisome of the 5th cranial nerve schwannoma.