What should a physical exam neurologic (neurological) for acoustic neuroma include?

From the Guidelines

A neurological exam for acoustic neuroma should include a comprehensive assessment of cranial nerves, particularly cranial nerve VIII, as well as evaluations for hearing loss, vestibular function, facial nerve function, and cerebellar function. The exam should assess hearing through whisper tests, tuning fork tests (Weber and Rinne), and evaluation for unilateral hearing loss, as most patients present with unilateral sensorineural hearing loss (94%) and tinnitus (83%) 1. Vestibular function should be evaluated through balance testing, Romberg test, and assessment for nystagmus, as vestibular symptoms such as vertigo and unsteadiness can occur in 17-75% of patients 1.

Key components of the neurological exam include:

• Cranial nerve testing, with a focus on cranial nerve VIII (vestibulocochlear nerve)
• Evaluation of hearing loss through whisper tests and tuning fork tests
• Assessment of vestibular function through balance testing and Romberg test
• Examination of facial nerve function (cranial nerve VII) for asymmetry, weakness, or paralysis
• Evaluation of adjacent cranial nerves (V, IX, X) for sensory or motor deficits
• Cerebellar function testing, including finger-to-nose, heel-to-shin, and gait assessment
• Fundoscopic examination to check for papilledema, which may indicate increased intracranial pressure from a large tumor

These components are essential because acoustic neuromas can affect the cerebellopontine angle and lead to increased intracranial pressure, and early detection through a thorough neurological examination can lead to earlier intervention and potentially better outcomes for patients with this benign but potentially debilitating tumor 1. Magnetic Resonance Imaging (MRI) is the gold standard for diagnosis and can identify other causes of sudden sensorineural hearing loss or findings that imply an underlying etiology 1.

From the Research

Physical Exam Neurologic for Acoustic Neuroma

A physical exam neurologic for acoustic neuroma should include:

• A thorough evaluation of cranial nerves, particularly the eighth cranial nerve, which is affected by the tumor 2
• An assessment of hearing loss and balance disturbances, as these are common symptoms of acoustic neuroma 2
• A examination of facial nerve function, as damage to this nerve can occur during tumor dissection 3
• An evaluation of other cranial nerves, such as the trigeminal nerve, which can be compressed by the tumor 4

Key Components of the Physical Exam

• Hearing evaluation: to assess the extent of hearing loss and determine the best course of treatment 2
• Balance evaluation: to assess the patient's balance and determine the risk of falls 2
• Cranial nerve examination: to assess the function of the eighth cranial nerve and other cranial nerves that may be affected by the tumor 3, 4
• Facial nerve examination: to assess the function of the facial nerve and determine the risk of facial palsy 3

Importance of the Physical Exam

• The physical exam is crucial in diagnosing acoustic neuroma and determining the best course of treatment 2
• The physical exam can help identify potential complications, such as cerebrospinal fluid leakage, damage to ancillary brain structures, facial nerve damage, and bleeding or vascular injury 2
• The physical exam can also help assess the patient's overall health and determine the risk of postoperative complications 5, 6