Download PDF
J Am Acad Audiol 2020; 31(06): 449-454
DOI: 10.3766/jaaa.19033
Case Report
American Academy of Audiology. All rights reserved. (2020) American Academy of Audiology

A Trigeminal Schwannoma Masked by Solely Vestibulocochlear Symptoms

Lauran K. Evans
1   Division of Otolaryngology, Department of Surgery, University of Nevada, Reno School of Medicine, Reno, NV
,
Lazaro Peraza
1   Division of Otolaryngology, Department of Surgery, University of Nevada, Reno School of Medicine, Reno, NV
,
Anthony Zamboni
1   Division of Otolaryngology, Department of Surgery, University of Nevada, Reno School of Medicine, Reno, NV
› Author Affiliations
Further Information

Publication History

Publication Date:
03 August 2020 (online)

   Permissions and Reprints

Abstract

Background Intracranial schwannomas are most commonly associated with the vestibulocochlear nerve, often leading to hearing loss, tinnitus, and vestibular dysfunction. Much less often, a schwannoma can arise from the trigeminal nerve which can lead to facial pain, numbness, and weakness.

Purpose We explored a case of a patient with an magnetic resonance imaging (MRI)-confirmed trigeminal schwannoma that was mistaken for a vestibulocochlear schwannoma because of a myriad of ipsilateral vestibulocochlear symptoms.

Research Design This is a retrospective chart review and case study, with no statistics applied.

Results This diagnostic error led to clinical confusion and inaccurate medical record-keeping. Radiologists and radiation oncologists deemed the patient's symptoms to be unrelated to the asymptomatic trigeminal schwannoma, and she was referred to an otolaryngologist following complaints of ear fullness, ear pain, and hearing loss. The patient's audiogram showed ipsilateral, asymmetric sensorineural hearing loss, and she was diagnosed with concurrent Meniere's disease. Alternative explanations, such as an additional schwannoma or external compression of the vestibulocochlear nerve, were considered, but not apparent on MRI.

Conclusions From this case, we see that symptoms do not always concur with imaging results and that multiple etiologies, especially when one is rare, can confuse a clinical picture.

Keywords

acoustic neuroma - medical error - neurilemmoma - trigeminal - vestibulocochlear
 

  • References

  • 1 Agarwal A. Intracranial trigeminal schwannoma. Neuroradiol J 2015; 28 (01) 36-41
    PubMedGoogle Scholar
  • 2 Arseni C, Dumitrescu L, Constantinescu A. Neurinomas of the trigeminal nerve. Surg Neurol 1975; 04 (06) 497-503
    Google Scholar
  • 3 Center of Disease Control. FY 2018 CD-10-CM. https://www.cdc.gov/nchs/icd/icd10cm.htm . Accessed February 8, 2018
  • 4 Chowdhury FH, Haque MR, Kawsar KA, Sarker MH, Hasan M, Goel AH. Intracranial nonvestibular neurinomas: young neurosurgeons’ experience. J Neurosci Rural Pract 2014; 5 (03) 231-243
    PubMedGoogle Scholar
  • 5 Coelho DH, Lalwani AK. Medical management of Meniere’s disease. Laryngoscope 2008; 118: 1099-1108
    CrossrefPubMedGoogle Scholar
  • 6 Fukaya R, Yoshida K. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev 2010; 34: 159-171
    PubMedGoogle Scholar
  • 7 Javalkar VK, Pigott T, Pal P, Findlay G. Multiple schwannomas: report of two cases. Eur Spine J 2007; 16 (03) 287-292
    CrossrefPubMedGoogle Scholar
  • 8 Harris DA, Mikulec AA, Carls SL. Autoimmune inner ear disease preliminary case report: audiometric findings following steroid treatments. Am J Audiol 2013; 22 (01) 120-124
    CrossrefPubMedGoogle Scholar
  • 9 Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandaia M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A. ; Classification Committee of the Barany Society; Japan Society for Equilibrium Research; European Academy of Otology and Neurotology (EAONO); Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS); Korean Balance Society. Diagnostic criteria for Meniere’s disease. J Vestib Res 2015; 25: 1-7
    CrossrefPubMedGoogle Scholar
  • 10 McCaslin DL, Rivas A, Jacobson GP, Bennett ML. The dissociation of video head impulse test (vHIT) and bithermal caloric test results provide topological localization of vestibular system impairment in patients with ’’definite” Meniere’s disease. Am J Audiol 2015; 24 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 11 Pearson BW, Brackmann DE. Committee on hearing and equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma): committee on hearing and equilibrium. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
    CrossrefPubMedGoogle Scholar
  • 12 Rigamonti D, Spetzler RF, Shetter A, Drayer BP. Magnetic resonance imaging and trigeminal schwannoma. Surg Neurol 1987; 28 (01) 67-70
    CrossrefPubMedGoogle Scholar
  • 13 Sajjadi H, Paparella MM. Meniere’s disease. Lancet 2008; 372 (9636): 406-414
    CrossrefPubMedGoogle Scholar
  • 14 Sharma BS, Ahmad FU, Chandra PS, Mahapatra AK. Trigeminal schwannomas: experience with 68 cases. J Clin Neurosci 2008; 15 (07) 738-743
    CrossrefPubMedGoogle Scholar
  • 15 Smith ME, Tysome JR. Tests of Eustachian tube function: a review. Clin Otolaryngol 2015; 40 (04) 300-311
    CrossrefPubMedGoogle Scholar
  • 16 Viirre E, Purcell I, Baloh RW. The Dix-Hallpike test and the canalith repositioning maneuver. Laryngoscope 2009; 115 (01) 184-187
    Google Scholar
  • 17 Zhang L, Yang Y, Xu S. Trigeminal schwannomas: a report of 42 cases and review of the relevant surgical approaches. Clin Neurol Neurosurg 2009; 111 (03) 261-269
    CrossrefPubMedGoogle Scholar