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Clinical Problem Solving: Radiology
September 2005

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(9):825. doi:10.1001/archotol.131.9.825-a

After MRI, the patient underwent a lumbar puncture. Examination of the cerebrospinal fluid sample showed malignant epithelial cells. The findings of chest radiography were normal, but cytologic analysis of a sputum specimen showed malignant squamous carcinoma cells; therefore, a diagnosis of bronchogenic squamous cell carcinoma with cerebral metastases was established.

Vestibular schwannoma is the most common enhancing lesion of the internal auditory canal.1 The appearance of the MRIs in the present case, with enhancing lesions in the internal auditory canals, initially suggested bilateral vestibular schwannomas, which frequently present with bilateral hearing loss and occasionally present with facial weakness.1 Bilateral vestibular schwannomas on MRIs suggest a diagnosis of neurofibromatosis 2 (NF-2). Neurofibromatosis 2 is an autosomal dominant condition with a genetic locus on chromosome 22. It is characterized by bilateral vestibular schwannomas and sometimes accompanied by schwannomas of other cranial and spinal nerves, intraspinal and intracranial meningiomas, and low-grade intracranial malignant neoplasms.2

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