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Clinical Problem Solving: Radiology
May 2013

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

SECTION EDITOR: C. DOUGLAS PHILLIPS, MD

JAMA Otolaryngol Head Neck Surg. 2013;139(5):520-521. doi:10.1001/jamaoto.2013.2653b

Diagnosis: Suspected arachnoid cyst of the right cerebellopontine angle

The patient's MRI images revealed a 21 × 16-mm lesion isointense to cerebrospinal fluid (CSF) in the right cerebellopontine angle without evidence of contrast enhancement, which was causing minimal mass effect on the anterior cerebellum with anterior displacement and compression of several lower cranial nerves, including the origin of the vestibulocochlear nerve. This lesion has imaging characteristics that are consistent with a diagnosis of an arachnoid cyst, although this is impossible to confirm absent a formal histologic examination. There was no evidence of endolymphatic sac or duct enlargement. It was concluded that the patient had a Meniere's disease–like clinical syndrome caused by compression of the vestibulocochlear nerve by the suspected arachnoid cyst.

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