Neurinomist of acoustics

The general information on the neurinomist of acoustics was developed in the principal article Neurinome. Here are detailed the symptomatic and clinical aspects.

The Neurinome of the Nerf vestibulocochléaire (VIIIe cranial pair) is a benign Tumeur whose clinical signs are variable and misleading: deafness of unilateral perception, Acouphène S, Giddiness S, facial paralysis, etc

Symptomatology

Generally one will meet:

  • a more or less permanent imbalance with type of yaw at the time of walk.
  • of the disorders of balance to the abrupt movements of the head.
  • an aggravation of the disorders of balance to the darkness.
  • of the unilateral auditive signs which are prevalent, old acouphenes, hypoacusia with bad comprehension.
  • more or less some giddinesses.

One will be able to also meet:

  • a crisis menièriforme starting.
  • a sometimes major imbalance at the older subjects (60/65 years).

Clinical signs

Signes vestibular:

  • horizonto-rotatory spontaneous nystagmus beating with dimensions healthy one but which is inconstant.
  • test of the vibratory stimulus (cf neuritis) but here associated with a unilateral deafness.
  • the aréflexie or important hyporéflexie unilateral with the heating tests is compensated most of the time and even in 10% of the cases the réflexie is normal.
  • not of signs of centrality at this stage

Signes auditive: (it is them which push the patient to be consulted)

  • deafness of unilateral perception.
  • abolition or rise in the threshold of the reflex stapédien.
  • bad vocal comprehension.
  • interval I/V lengthened at the P E or traced disorganized.

One will confirm the diagnosis by a IRM.

3 paramount things will have to be retained:

  1. in front of any deafness of perception, to explore the vestibular function systematically.
  2. in front of a vestibular giddiness with aréflexie, the absence of auditive deficit does not eliminate a neurinomist.
  3. a normal heating examination plus a deafness of perception do not eliminate either a neurinomist.

To become Evolutionary

The development of the schwannomist in the ponto-cérébelleux angle highlights pilot central vestibular signs of the compression of the cerebral trunk and cérébelleux flocculus. These signs are:

  • anomaly of the ocular test of fixing.

  • nystagmus of the central type (vertical, pure and multidirectional or perverted nystagmus).
  • abnormal oculography, dysmétries of the jerks or the saccadic continuations.
  • possibility of attack of V and or the VII
  • cérébelleux signs, hypertension will intra cranial.

Treatment

According to the degree of evolution of the neurinomist, the doctor will prescribe a simple monitoring, a Radiothérapie or a surgical operation (very delicate intervention whose principle is to remove the tumor what sometimes requires to cut the cochléo-vestibular nerve).

The radio-surgical treatment is the treatment most frequently carried out (and also most easily tolerated) when the tumor does not exceed a certain size. In France, it is carried out only in Marseilles or Lille.

The surgical treatment, reserved for the more consequent tumors, is generally carried out by translabyrinthic way of access. It imposes an important convalescence and a rehabilitation, within the framework of a unilateral vestibular attack by section of the VIII.

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