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Clinical Problem Solving: Radiology
Aug 2011

Radiology Quiz Case 3

Author Affiliations
 

SECTION EDITOR: C. DOUGLAS PHILLIPS, MD

Arch Otolaryngol Head Neck Surg. 2011;137(8):825. doi:10.1001/archoto.2011.125-a

A 51-year-old man presented with a 10-month history of vertigo, nonpulsatile tinnitus, and progressive right-sided hearing loss. He was otherwise in good health and had no history of otologic infections or operations. He did not smoke or drink alcohol, and there was no relevant family history.

Physical examination revealed intact facial strength and sensation and was remarkable only for hearing loss. Audiometric testing confirmed profound right-sided sensorineural hearing loss. An electronystagmogram showed normal caloric function bilaterally and abnormal direction-fixed nystagmus during static positional testing. A postgadolinium axial T1-weighted magnetic resonance image (MRI) of the right internal auditory canal demonstrated a 3 × 4 x 3.5-mm enhancing lesion arising within the vestibule (Figure 1). T2-weighted MRIs showed a hypointense lesion within the right vestibule (Figure 2 and Figure 3).

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