Clinical features

The clinical features of acoustic neuroma are:

• occipital pain on the side of the tumour
  
  
• VIII nerve damage
  • about 90% of patients presents with unilateral sensorineural deafness developing gradually over a period of months or years
  • around 5% will have sudden hearing loss
  • vertigo which may be quite mild and tinnitus (around 70%) are common (1)
  • caloric paresis may be demonstrable.
• V nerve damage - depression of corneal reflex occurs early. Facial pain, paraesthesia and numbness develop (1) .
  
  
• VII nerve damage - facial weakness is unusual.(1)
  
  
• IX, X, XI nerve damage - rare; presents as dysphagia, change in voice, palatal weakness.
  
  
• compression effects of large tumours:
  • on cerebellum - ataxia, loss of co-ordination on ipsilateral side, nystagmus
  • on pons - contralateral hemiparesis
  • on aqueduct and 4th ventricle - raised intracranial pressure, e.g. headache (1)

Reference:

• (1) British association of otorhinolaryngologists 2002. Clinical effectiveness guidelines, Acoustic neuroma (vestibular schwannoma)