Acoustic neuroma with obstructive hydrocephalus

Case contributed by Dr Ammar Haouimi

Presentation

Signs of raised intracranial pressure in a full-term pregnant patient.

Patient Data

Age: 40 years
Gender: Female

There is a well-circumscribed extra-axial mass at the left cerebellopontine angle measuring (42 x 40 x 38 mm) with moderate enlargement of the proud acusticus. It elicits a low signal on T1, heterogeneous high signal on T2 and FLAIR with no restricted diffusion. Postcontrast sequences were not performed (pregnant patient).

A mass effect is noted on the left middle cerebellar peduncle, brainstem, and the cisternal portion of the trigeminal nerve as well as the cerebellar hemisphere and 4th ventricle which is compressed and displaced to the right.

Dilated 3rd and lateral ventricles with transependymal edema in keeping with obstructive hydrocephalus

Case Discussion

MRI features of a probable acoustic neuroma of left CPA compressing the middle cerebellar peduncle, brainstem, cerebellar hemisphere, cisternal portion of the trigeminal nerve, and 4th ventricle with secondary obstructive hydrocephalus.

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