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

Abstract

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.

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

“…The decision for neuro-oncological intervention demands multidisciplinary and patient-specific approaches in a pregnant woman. Factors to be considered include the type of lesion, location, neurological condition, the fetal gestational age, prognosis and the hazards of using a conservative strategy towards the pregnant woman 6–8. Ideally, surgery should be avoided in the first and third trimesters to avoid risks of spontaneous abortion and preterm labour, respectively.…”

Let Us Not Forget About Bleeding: A Case Report and Brief Literature Review on Hemorrhagic Vestibular Schwannoma

“…Non-HVS instances, on the other hand, report these symptoms in 10% of cases. Furthermore, there is a reported 10% risk of mortality in hemorrhagic instances, which is a significant consequence when compared to individuals with a 0.2% chance of death in non-HVS [5,6,[10][11][12][13]. Although many symptoms are comparable in hemorrhagic and non-HVS, severe headache, acute hearing loss, facial hemiparesis, ataxia, diplopia, dizziness, nausea, and vomiting have been found to be more common in hemorrhagic VS (the so-called acoustic apoplexy syndrome) [5,11].…”

“…Furthermore, there is a reported 10% risk of mortality in hemorrhagic instances, which is a significant consequence when compared to individuals with a 0.2% chance of death in non-HVS [5,6,[10][11][12][13]. Although many symptoms are comparable in hemorrhagic and non-HVS, severe headache, acute hearing loss, facial hemiparesis, ataxia, diplopia, dizziness, nausea, and vomiting have been found to be more common in hemorrhagic VS (the so-called acoustic apoplexy syndrome) [5,11]. In the current case, it is likely that the abrupt intratumoral bleeding, which caused an increase in local pressure in the posterior fossa, aggravated a preexisting compression by the VS, exacerbating the symptomatic presentation.…”