A Simple Guide to Acoustic neuroma

A Simple Guide to Acoustic neuroma
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What are Acoustic neuroma ?
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Acoustic neuroma is a neurofibroma of the eight nerve.


Who are at risk of Acoustic neuroma?
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1.Both sexes are equally affected.

2.Acoustic neuroma occurs more in the 50- 60 age group.

3.It forms 5-10% of the intracranial tumors in adults.


What are the different types of Acoustic neuroma?
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1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.

b. occurs in adult life,

c. the tumor involve the 8th nerve,

d. can involve any other cranial nerve or the spinal root.

e.Incidence is usually 90-95%

2.Neurofibroma II -
a. bilateral acoustic neuromas are common

b. occurs before the age of 21.

c. affects the entire nerve

d. autosomal dominant inheritance.

e. Incidence is about 5 to 10%.


What are the Causes of Acoustic neuroma?
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Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.

The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.

Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.

If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.


What are the symptoms and signs of Acoustic neuroma?
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Symptoms:
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1.unilateral hearing loss

2.tinnitus with unilateral high-pitched ringing sound

3.loss of sense of balance

4.vertigo

5.nausea and vomiting

6.altered gait

7.pressure in the ear

8.rarely headache and altered consciousness.

Signs:
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1.unilateral facial weakness.

2.sensory impairment of the nerve

3.impairment of glandular secretions

4.loss of taste

5.loss of sensation in one side of the face and mouth

6.rarely altered gag or swallowing reflexes.


How are diagnosis of Acoustic neuroma made?
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1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter

2.MRI with gadolinium enhancement may show even smaller tumors

3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.


What is the Treatment of Acoustic neuroma?
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Treatment of acoustic neuroma is usually by surgery and radiotherapy.

Conservative treatment
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In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.

This method is common among patients over 70 years old.

In rare cases, acoustical neuroma have been known to disappear spontaneously.

Acoustic neuroma may result in gradual hearing loss and tinnitus.


Surgery
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Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.

The superior and inferior vestibular nerves are removed at surgery.

This effectively restores balance in the patient.

Radiation treatment
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Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.


What is the Prognosis of Acoustic neuroma?
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Prognosis is good in all early diagnosis and small tumors.

Large tumors may give rise to residual neurolgical damage even afer removal.

A Simple Guide to Thyroid Nodules

A Simple Guide to Thyroid Nodules
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What are Thyroid Nodules ?
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Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.


Who are at risk of thyroid nodule?
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1.Thyroid nodules are more common in females than in male.

2.However the thyroid nodule in males are more prone to malignancy than in females

3.Thyroid nodules occurs more in the 30- 60 age group.


What are the different types of Thyroid Nodules?
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1.solid - solid thyroid nodules which may or not feel hard

2.cystic - the nodules is filled with fluid.

3.benign - non malignant

4.malignant - cancerous


What are the symptoms and signs of Thyroid Nodules?
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In mild cases there is usually no obvious symptoms.

In moderate or severe cases of thyroid nodules:

Symptoms:
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1.Obvious swelling in the thyroid gland

2.Neck swelling -suuggest presence of spread to the lymph node

3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord

4.Dyspnea or breathlessness if there is pressure on the trachea

5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus


Signs:
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1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.

2.Cystic nodules may feel hard while solid nodules may be soft to firm.

3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.

4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.


How are diagnosis of Thyroid Nodules made?
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1.blood test for thyroxine and TSH levels

2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.

The biopsied material is then sent to the lab for tests to look for any malignant cells.

3.ultrasound scans are done to differentiate between solid and cystic nodules,

4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.

5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.


What is the Treatment of Thyroid Nodules?
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Benign lumps can be monitored by doctors at regular intervals.

If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.

Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.


What is the Prognosis of Thyroid Nodules?
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Prognosis is good in all benign cases.

Malignant thyroid nodules will depend on any spread to other organs.