Lịch sử của cô bắt đầu từ 1 tháng trước đây với sự sụt giảm đột ngột nghe trong tai phải của cô. Một tuần trước chuyến thăm này, cô bắt đầu nhận thấy điểm yếu của khuôn mặt phải, mà bây giờ đã tiến bộ để hoàn thành tê liệt. Trong 3 tháng vừa qua, cô đã liên tục phải đau đầu chẩm | CASE 52 A 43-year-old right-handed woman presents to the office with hearing loss facial paralysis and headache. Her history began 1 month ago with a sudden decrease in hearing in her right ear. One week prior to this visit she began to notice weakness of the right face which has now progressed to complete paralysis. Over the last 3 months she has had intermittent right occipital headache and clumsiness and imbalance if she turns quickly. She denies any change in her voice or difficulty with swallowing or swallowing difficulty. Her past medical history is unremarkable. She is not on any medications except birth control pills. Her physical examination shows a 43-year-old woman that has an obvious right facial paralysis. Her pulse is 62 beats min blood pressure 118 62 mmHg and temperature C F . The head and face have no lesions. Her voice is normal but her speech is slightly distorted because of the facial paralysis. Her extra-ocular movements are normal. Her eye grounds do not show any papilledema. Her ears have normal tympanic membranes. The Weber tuning fork lateralizes to the left ear. Air conduction is louder than bone conduction in both ears. There is no neck lymphadenopathy or other masses. There are no cerebellar signs. The remaining physical examination including the neurologic examination is normal. An audiogram shows a mild sensorineural hearing loss in the right ear the left ear has normal hearing. An auditory brainstem response ABR is abnormal for the right ear it is normal for the left ear. What is the most likely neuroanatomic etiology and diagnosis What is the next diagnostic step 434 CASE FILES NEUROLOGY ANSWERS TO CASE 52 Meningioma of the Acoustic Nerve Summary . A 43-year-old woman has a history of headache hearing loss and facial paralysis. Neuroanatomic Etiology and Diagnosis Cerebellopontine angle tumor with the most common tumors being acoustic neuroma and meningioma Next diagnostic step MRI with gadolinium Analysis Objectives 1. .
