Cerbellopontine angle lesions

Question 1

Where is the cerebellopontine angle (CPA) located?

Answer 1

Between the cerebellum and the pons

Question 2

What cells are acoustic neuromas related to?

Answer 2

Schwaan cells around the auditory nerve that innervates the inner ear.

Question 3

Describe the progression of an acoustic neuroma

Answer 3

Slow growing

Question 4

What is another name for an acoustic neuroma?

Answer 4

Vestibular schwannoma

Question 5

What is an acoustic neuroma?

Answer 5

Benign subarachnoid tumour that causes local pressure effects on the vestibulocochlear nerve.

Question 6

What is presentation of acoustic neuroma/vestibular schwannoma?

Answer 6

The classical history of vestibular schwannoma includes:
- vertigo
- unilateral sensorineural hearing loss
- progressive, ipsilateral tinnitus AND
- absent corneal reflex.

Other symptoms:
- dizzy
- headaches
- disequilibrium

Question 7

What symptoms of acoustic neuroma/aka vestibular schwannoma are present due to effects on cranial nerve VIII?

Answer 7

Vertigo
Unilateral sensorineural hearing loss
Unilateral ipsilateral tinnitus

Question 8

What symptoms of acoustic neuroma/aka vestibular schwannoma are present due to effects on cranial nerve V?

Answer 8

Absent corneal reflex

Question 9

What symptoms of acoustic neuroma/aka vestibular schwannoma are present due to effects on cranial nerve VII?

Answer 9

Facial palsy

Question 10

What condition are bilateral vestibular schwannomas seen in?

Answer 10

Neurofibromatosis type 2

Question 11

Investigations for acoustic neuroma/aka vestibular schwannoma?

Answer 11

Urgent referral to ENT
MRI of cerebellopontine angle - rule out malignancy
Audiometry

Question 12

Management for acoustic neuroma/aka vestibular schwannoma?

Answer 12

Surgery = definitive management
Radiotherapy
Observation = if small lesion, can have 6 month interval scan.