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Vestibular schwannoma — SCE Neurology MCQ

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ModerateNeuro-oncologyVestibular schwannomaSCE Neurology

A 27-year-old man presented with progressive unilateral hearing loss, tinnitus and imbalance. On examination, there was reduced corneal reflex and sensorineural deafness. Initial investigations showed: MRI internal auditory meatus showed enhancing cerebellopontine angle lesion. What is the most likely underlying mechanism?

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Correct answer: E — Schwann-cell tumour of vestibular nerve

Schwann-cell tumour of vestibular nerve is the best answer because the vignette describes Vestibular schwannoma: unilateral vestibulocochlear symptoms with IAC lesion indicate vestibular schwannoma. JC virus infection of oligodendrocytes is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Small-vessel lipohyalinosis and Prion protein misfolding are less appropriate because they would require different localisation, timing or test findings; Functional abnormality of motor prediction networks would fit a different syndrome. Clinical pearl: Meniere disease lacks CPA mass and corneal reflex change.

Reference: NICE NG99; EANO guidance; ABN paraneoplastic guidance