Abstract
Background/Setting A subject presenting with a unilateral sensorineural hearing loss and with vertigo/imbalance
and a lesion of internal acoustic meatus (IAM) most often represents a vestibular
schwannoma. Several alternative pathologies involving the region, with clinical and
neuroradiological similarities, could lead to an error in judgement and management.
Rare tumors of the IAM pose unique diagnostic difficulty. A rare case that we present
here had a typical history and imaging findings suggestive of vestibular schwannoma.
A primary central nervous system (CNS) lymphoma was diagnosed in later stages of brain
involvement warranting a retrospective analysis of the entity.
Case Summary An 80-year-old male presented with unilateral sensorineural hearing loss, vertigo,
and imbalance. On imaging, he was found to have a lesion in the left internal auditory
meatus, reported as a vestibular schwannoma and operated upon. Subject's condition
worsened with time and a repeat imaging was suggestive of a CNS lymphoma with lesions
involving bilateral cerebellum and subcortical white matrix.
Conclusion To conclude, primary CNS lymphoma presenting an isolated lesion in the IAM with no
other parenchymal lesions at presentation is a rare incidence; to our knowledge this
is the first case of such unique presentation.
Keywords
vestibular schwannoma - internal acoustic meatus - CNS lymphoma - imaging of internal
acoustic meatus lesions
