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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.

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Which choice is most appropriate?

Extra-axial, intracranial mass.Subdural hemorrhage.Frontal lobe mass.Subarachnoid hemorrhage.Calvarial mass.
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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.Image
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Teenage boy with hoarseness.

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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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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: 

  1. Adv Otorhinolaryngol. 2011;70:91-8. Epub 2011 Feb 24. Neurofibromatosis type 2. Evans GR, Lloyd SK, Ramsden RT.
  2. Statdx. 08/03/2011
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Teenage boy with hoarseness.


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