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Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case

BACKGROUND: Acute intratumoral hemorrhage within a vestibular schwannoma, or vestibular apoplexy, is a rare condition. Unlike the typical insidious vestibulopathy typically caused by vestibular schwannoma growth, patients with vestibular apoplexy have an acute and severe presentation with nausea and...

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Autores principales: Avalos, Lauro N., Morshed, Ramin A., Goldschmidt, Ezequiel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379692/
https://www.ncbi.nlm.nih.gov/pubmed/36303506
http://dx.doi.org/10.3171/CASE21722
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author Avalos, Lauro N.
Morshed, Ramin A.
Goldschmidt, Ezequiel
author_facet Avalos, Lauro N.
Morshed, Ramin A.
Goldschmidt, Ezequiel
author_sort Avalos, Lauro N.
collection PubMed
description BACKGROUND: Acute intratumoral hemorrhage within a vestibular schwannoma, or vestibular apoplexy, is a rare condition. Unlike the typical insidious vestibulopathy typically caused by vestibular schwannoma growth, patients with vestibular apoplexy have an acute and severe presentation with nausea and emesis in addition to severe vertigo and hearing loss. Here, the authors present an illustrative case demonstrating this rare clinical condition and an operative video detailing the surgical management. OBSERVATIONS: A 76-year-old man presented to the emergency department with acute-onset dizziness, left-ear fullness, double vision, gait ataxia, emesis, and facial numbness. Imaging revealed a 2.8-cm hemorrhagic left cerebellopontine angle lesion extending into the left internal auditory canal, consistent with hemorrhagic vestibular schwannoma. The patient subsequently underwent a retrosigmoid craniotomy for resection of the hemorrhagic mass, and by 1 month after surgery, all his presenting symptoms had resolved, allowing his return to daily activities. LESSONS: Vestibular schwannomas typically present with decreased hearing and chronic vestibulopathy. Acute presentation should raise the suspicion for an apoplectic event, and surgical debulking may lead to improvement in most vestibular symptoms.
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spelling pubmed-93796922022-10-04 Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case Avalos, Lauro N. Morshed, Ramin A. Goldschmidt, Ezequiel J Neurosurg Case Lessons Case Lesson BACKGROUND: Acute intratumoral hemorrhage within a vestibular schwannoma, or vestibular apoplexy, is a rare condition. Unlike the typical insidious vestibulopathy typically caused by vestibular schwannoma growth, patients with vestibular apoplexy have an acute and severe presentation with nausea and emesis in addition to severe vertigo and hearing loss. Here, the authors present an illustrative case demonstrating this rare clinical condition and an operative video detailing the surgical management. OBSERVATIONS: A 76-year-old man presented to the emergency department with acute-onset dizziness, left-ear fullness, double vision, gait ataxia, emesis, and facial numbness. Imaging revealed a 2.8-cm hemorrhagic left cerebellopontine angle lesion extending into the left internal auditory canal, consistent with hemorrhagic vestibular schwannoma. The patient subsequently underwent a retrosigmoid craniotomy for resection of the hemorrhagic mass, and by 1 month after surgery, all his presenting symptoms had resolved, allowing his return to daily activities. LESSONS: Vestibular schwannomas typically present with decreased hearing and chronic vestibulopathy. Acute presentation should raise the suspicion for an apoplectic event, and surgical debulking may lead to improvement in most vestibular symptoms. American Association of Neurological Surgeons 2022-04-04 /pmc/articles/PMC9379692/ /pubmed/36303506 http://dx.doi.org/10.3171/CASE21722 Text en © 2022 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Lesson
Avalos, Lauro N.
Morshed, Ramin A.
Goldschmidt, Ezequiel
Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title_full Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title_fullStr Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title_full_unstemmed Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title_short Hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. Illustrative case
title_sort hemorrhagic vestibular schwannoma: a case example of vestibular apoplexy syndrome. illustrative case
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379692/
https://www.ncbi.nlm.nih.gov/pubmed/36303506
http://dx.doi.org/10.3171/CASE21722
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