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Vertigo, Imbalance, Headache. Physical Therapy Prescribed. MRI Shows Acoustic Neuroma. What Tests Are Required ?

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Posted on Sun, 10 Jun 2012
Question: possible acoustic neuroma on mri
doctor
Answered by Dr. Praveen K Nath (18 hours later)
Hi,

Thanks for the query.

I have noted your details and reviewed the pictures sent to me.

It looks like that your headache & vertigo may be secondary to this lesion. 'Acoustic neuroma' is a possibility. I suggest you to go for detailed MRI brain with contrast. Pure tone Audiometry (PTA) done under the guidance of a competent ENT specialist will help in the diagnosis.

As the tumor size is small, I think it can be best managed with gamma knife treatment. Histopathological study of the lesion (after surgical excision) will confirm the diagnosis.

Discuss with your surgeon regarding the aforementioned diagnostic tests and gamma knife treatment.

Hope my answer is helpful and informative. Should you have any additional queries with regards to my recommendations, I will be available to help you further.

Wishing you good luck

Regards
Dr. Praveen K Nath XXXXXXX Consultant Neurosurgeon

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Praveen K Nath (7 hours later)
Is there any way this could be a lesion or bone or anything else and not a mass? I know its not likely but....
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Follow up: Dr. Praveen K Nath (22 hours later)
is there anything else this could be other than a tumor? I realize it is quite small at 1.7 cm and probably not a big deal. I know usually with 'Acoustic neuroma' hearing loss is a symptom but I dont have that I do have pain pressure in ear and throat, headaches and other cooridination problems. Does the mass have to be removed?
doctor
Answered by Dr. Praveen K Nath (21 minutes later)
Hello.

Thanks for writing back.

This is unlikely to be a bony lesion. It appears as soft tissue lesion/mass.

However it is difficult to comment based on one single image. We need multiple sequences of MRI brain with contrast to comment in detail.

Apart from Acoustic Neuroma, other differential diagnosis which can be considered are infectious lesions, cysts, rarely hamartomas.

Final confirmation is done only after histopathology examination of mass removed by surgery.

In Acoustic Neuroma, initially hearing loss may be partial, can be detected only by Audiometry. Difficulty in coordination is also another sign of Acoustic Neuroma.

I would suggest you get the MRI brain with contrast and Audiometry done. It will give near total confirmation.

If it is Acoustic Neuroma of this small size, can be easily handled without surgery with good results by Gamma knief Radiosurgery (radiation treatment).

I hope, this answers your query.

Wish you good health.

Regards.

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Praveen K Nath (24 hours later)
I spoke with my nuerologists nurse today and she didnt mention a mass from MRI. I then specifically asked about it and her response was that he glanced at them when he came in and said he did'nt see anything unusual that would be causing the severe headaches, vertigo, etc. His only recomendation was physical therapy to help with the sudden balance problems I am having. I can see the mass and you could as well so Im confused. I have additional images if you let me know what enhancement and view you want.
doctor
Answered by Dr. Praveen K Nath (22 hours later)
Hello.

Thanks for writing back.

I have taken a curbside consult with Neurologist to answer your query.

I would like to know, whether the MRI is reported by a Radiologist. If not, get it reported by experienced Neuro-radiologist for clarity of lesion or discuss with your treating Neurologist.

You can send me some more sagittal and axial cuts of MRI if you have.

Ideally, it is advisable to do MRI with contrast for getting additional information. Audiometry will help to predict the diagnosis.

The symptoms you describe like, vertigo, imbalance and headache in presence of suspected mass on MRI are suggestive of Acoustic Neuroma.

Kindly discuss with your Neurologist about getting these tests done.

I hope, this answers your query.

Wish you good health.

Regards.

Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Praveen K Nath

Neurologist, Surgical

Practicing since :1996

Answered : 147 Questions

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Vertigo, Imbalance, Headache. Physical Therapy Prescribed. MRI Shows Acoustic Neuroma. What Tests Are Required ?

Hi,

Thanks for the query.

I have noted your details and reviewed the pictures sent to me.

It looks like that your headache & vertigo may be secondary to this lesion. 'Acoustic neuroma' is a possibility. I suggest you to go for detailed MRI brain with contrast. Pure tone Audiometry (PTA) done under the guidance of a competent ENT specialist will help in the diagnosis.

As the tumor size is small, I think it can be best managed with gamma knife treatment. Histopathological study of the lesion (after surgical excision) will confirm the diagnosis.

Discuss with your surgeon regarding the aforementioned diagnostic tests and gamma knife treatment.

Hope my answer is helpful and informative. Should you have any additional queries with regards to my recommendations, I will be available to help you further.

Wishing you good luck

Regards
Dr. Praveen K Nath XXXXXXX Consultant Neurosurgeon