Vestibular schwannoma of oscillating size: A case report and review of literature

Abstract

Background:Vestibular schwannomas are benign brain tumors arising from the 8th cranial nerve with a varying natural history. Various reports have described discernable growth patterns for these tumors. However, growth predictability remains low because of slow and indeterminate changes over time with follow-up reports not usually exceeding 3 years. Our report describes the long-term follow-up of an unusual cystic schwannoma with growth patterns prior to and following treatment, adding valuable information to the variable natural history and outcome of these infrequent tumors.Case Description:A 68-year-old gentleman presented with a left-sided cystic vestibular schwannoma, initially managed conservatively. Imaging revealed wide variations in the size of his tumor over a period of 3 years. He was finally treated with Gamma Knife radiosurgery, and at 1 year following treatment shows tumor shrinkage with a change in tumor morphology.Conclusion:To our knowledge, the present case represents the first instance of a schwannoma showing wide fluctuations in tumor size and morphology over a period of time, with a good response to radiosurgery. We emphasize in this report that there is no “one size fits all” treatment paradigm for these tumors and each patient requires individualized care and intervention, taking into account their differing natural histories.

Immediate type hypersensitivity and late phase reaction occurred consecutively in a patient receiving ethambutol and levofloxacin

“…The patient’s reaction to ethambutol was assessed first among the three suspected drugs using an oral challenge test. Levofloxacin, which was not among the suspected drugs, was administered to the patient with ethambutol in order to avoid the risk of drug resistance resulting from the administration of a single drug [ 1 , 2 ]. The patient presented urticarial lesions with pruritus within 1 h without other immediate type reaction such as, asthmatic reaction or rhinitic symptoms.…”

Extended Vestibular Schwannoma Presenting as an External Auditory Canal Mass: Two New Cases and Review of the Literature

“…1) And VS have a slow growth rate, as previously reported in the literature, with overall mean growth rates ranging from 1.15 to 2.4 mm/year. 2) So the lateral extension of a VS involving the middle ear is very rarely reported. Furthermore, it is even more rarely to be found in the form of an external auditory canal (EAC) mass and only a few cases have been reported in the literature to date.…”