A 45-year-old woman presents with progressive unilateral right-sided sensorineural hearing loss and tinnitus for 2 years. Speech discrimination is disproportionately poor compared to the pure tone thresholds. MRI reveals a homogenously enhancing mass in the right cerebellopontine angle extending into the internal auditory canal. The most likely diagnosis is:
- A Meningioma
- B Epidermoid cyst
- C Vestibular schwannoma ✓
- D Glomus jugulare
Correct answer: C. Vestibular schwannoma
Explanation
Vestibular schwannoma classically presents with unilateral sensorineural hearing loss, tinnitus, and disproportionately poor speech discrimination. MRI shows a cerebellopontine angle mass that enhances and extends into the internal auditory canal, producing an ice-cream cone appearance. It is the most common CPA tumor. Meningiomas typically show a dural tail and do not extend into the internal auditory canal. Epidermoid cysts are non-enhancing and show restricted diffusion.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.