Vestibular Schwannoma – CPA Mass — SCE Neurology MCQ

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EasyNeuro-oncologyVestibular Schwannoma – CPA MassSCE Neurology

A 50-year-old man presents with progressive bilateral sensorineural hearing loss and a left cerebellopontine angle (CPA) mass on MRI. The mass is enhancing and centred on the internal auditory canal. What is the most likely diagnosis?

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Correct answer: D — Vestibular schwannoma (acoustic neuroma)

Vestibular schwannomas (acoustic neuromas) arise from the Schwann cells of the vestibular division of CN VIII, typically at the cerebellopontine angle. They are the most common CPA mass and present with progressive unilateral (or asymmetric bilateral in NF2) sensorineural hearing loss, tinnitus, and unsteadiness. MRI shows an enhancing mass centred on the internal auditory canal extending into the CPA cistern (ice cream cone shape). Management options include observation (small tumours), stereotactic radiosurgery, or microsurgery. A: Meningiomas are dural-based, not centred on the IAC. C: Epidermoid cysts do not enhance. D: Arachnoid cysts follow CSF signal. E: Glomus tumours are at the jugular foramen.

Reference: NICE NG99; WHO CNS Classification