differential diagnosis of cerebellopontine angle lesions
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Differential Diagnosis of Cerebellopontine Angle lesions. By: Nour-Eldin A Mohammed Referrence:Stephan Chapman 2003. Cerebellopontine Angle. Extra-axial area lateral to the prepontine cistern containing CSF, arachnoid tissue, cranial nerves and their associated vessels. Borders

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differential diagnosis of cerebellopontine angle lesions

Differential Diagnosis of Cerebellopontine Angle lesions

By:

Nour-Eldin A Mohammed

Referrence:Stephan Chapman 2003

cerebellopontine angle
Cerebellopontine Angle
  • Extra-axial area lateral to the prepontine cistern containing CSF, arachnoid tissue, cranial nerves and their associated vessels.

Borders

  • Medial: lateral surface of the brainstem
  • Lateral : petrous bone
  • Superior : middle cerebellar peduncle & cerebellum
  • Inferior : arachnoid tissue of lower cranial nerves
  • Posterior : cerbellar peduncle
differential diagnosis
Differential Diagnosis:
  • Vestibular Schwannoma (acoustic neuroma). Most Common Cause
  • Meningioma
  • Epidermoid cyst
  • Trigeminal neuroma
  • Vertebrobasilar system aneurysm
  • Metastases
  • Skull base/temporal bone tumours:eg, glomus tumors,metastases,cholesterol granuloma
  • Skull base infection:osteomyelitis of the petrous apex (Gradengo’s syndrome) , Malignant otitis externa
acoustic neuroma
Acoustic Neuroma
  • Comprises 60-92% of CPA lesions
  • Involve the vestibular division of the 8th cranial nerve
slide7

Features of Acoustic Neuroma:

  • Centered over the petrous bone
  • Acute angle with the petrous bone
  • Extension into the internal auditory canal
  • Homogenous enhacement
  • No dural tail
  • No calcifications
meningioma
Meningioma:
  • Second most common CPA lesion 3-7 %
  • Arise from cap cells near arachnoid villi which are more prominent near cranial nerve foramina and venous sinuses.
  • Usually arise from posterior surface of the petrous bone and usually do not extend into IAC
slide10

Features of Meningioma:

  • Broad base over the petrous bone
  • Homogenous signal
  • A small toungue extension into the internal auditory canal without widening it
  • Homogenous enhacement
  • dural tail
  • Calcifications , psammoma bodies
  • Hyperostosis
epidermoid cyst
Epidermoid Cyst:
  • Accounts for 2-6 % of CPA masses
  • Congenital lesions that present in adulthood
  • Rests of ectodermal tissue containing stratified squamous lining and keratin
  • May arise within the temporal bone or in the CPA
slide12

Features of Epidermoid:

  • Low density Cyst with lobulated margin
  • CSF like signal (with high signal in diffusion,flair and proton seq
  • May exert extensive mass effect
  • Also occur parasellar and rarely itradiploic

TI WI

T2 WI

Proton WI

trigeminal neuroma
Trigeminal Neuroma
  • Similar to vestibular neuoma but arises from the trigeminal nerve
vascular lesions
Vascular Lesions:

1. Vertebrobasilardolichoectasia:

Enlongation and dilitation of the vertebrobasilar artery.

Symptomas : Facial spasm, trigeminal neuralgia

2. AICA loop

May loop over, under, or between CN VII & CN VIII.

Symptoms - vertigo

3. Giant Aneurysms

4. Hemangioma

5. Paragangliomas (may extend to CPA)

GlomusJugulare

GlomusTympanicum

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