Case of the Day(sm)

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Teenage boy with hoarseness.

Our appreciation is extended to Dr. Daniel Sova,
Indiana University Department of Radiology,
for contributing this case.

History: Teenage boy with hoarseness.

Click these MR images to enlarge them.

Which choice is most appropriate?

Extra-axial, intracranial mass.Subdural hemorrhage.Frontal lobe mass.Subarachnoid hemorrhage.Calvarial mass.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Teenage boy with hoarseness.

Review the image below (same patient). What is the salient finding?

Basilar artery aneurysm.Sellar mass.Unilateral IAC mass.Bilateral IAC masses.Fourth ventricle mass.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Teenage boy with hoarseness.

Findings: 1. A large left frontal mass is identified with homogeneous contrast enhancement and displacement of the adjacent brain tissue 2. Bilateral internal auditory canal masses

Differential diagnosis:

Differential diagnosis for left frontal mass:
- Meningioma
- Hematoma
- Dural metastasis
- Lymphoma
- Neurosarcoidosis.
Differential diagnosis for internal auditory canal/CPA mass:
- Meningioma
- Schwannoma
- Epidermoid cyst
- Metastases
- Sarcoidosis

Can you derive a unifying diagnosis? (Revealed on next page).

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Teenage boy with hoarseness.

UNIFYING DIAGNOSIS: Neurofibromatosis Type II

Key points:

Mnemonic: MISME: Multiple intracranial schwannomas, meningiomas, and ependymomas
Classic appearance of a schwannoma is "Ice cream cone" in CP angle
Genetic defect on chromosome 22q12
Look for other cranial nerve involvement for additional schwannomas
60-67% 10 year survival after diagnosis

References: