Short case publication... version 1.19 | Edited by professor Yasser Metwally | April 2008
Professor Yasser Metwally
Professor of neurology
Ain Shams university school of medicine
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A 22 years old male patient presented clinically with bilateral tinnitus, headache, bilateral diminution of hearing, bilateral
papilledema, bilateral facial nerve palsy, bulbar cranial nerves dysfunction, right sided cerebellar manifestation and
bilateral long tract dysfunction.
DIAGNOSIS: NEUROFIBROMATOSIS TYPE 2
Figure 1. Bilateral vestibular schwannomas. The bilateral cerebellopontine angle tumors are hypointense on
the precontrast MRI T1 images (Antoni B schwannomas). Notice that the brain stem is bilaterally compressed
and squeezed by the bilateral tumors. Also notice the CSF cleft that separates the bilateral tumors from the
neural tissues (The tumors are extra-axial). Moderate degree of hydrocephalus is present.
Figure 2. Bilateral vestibular schwannomas. Postcontrast MRI T1 images showing dense and uniform contrast
enhancement of the bilateral tumors.
Figure 3. Bilateral vestibular schwannomas. MRI T2 and FLAIR images. The tumors have heterogenous signal
on both T2 and FLAIR images with hyperintense zones which, most probably, represent cystic (fluid -filled)
areas (Antoni B tissues).
Figure 4. Bilateral vestibular schwannomas. MRI FLAIR images. Notice the moderate hydrocephalic changes and
the transependymal edema. Also notice the CSF cleft that separates the tumor from the brain stem. The tumor
hyperintensity is due to the existence of cystic changes (Antoni B tissues).
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For an archive of the previously reported cases go to www.yassermetwally.net, then under pages in the right panel,
scroll down and click on the text entry quot;downloadable short cases in PDF formatquot;
1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency
for electronic publishing, version 9.1a January 2008