When Falls Reveal More: The Geriatric Giant Unveils a Vestibular Schwannoma

Vestibular schwannomas (VSs) are benign tumors originating from Schwann cells of the vestibular component of the eighth cranial nerve. They classically present as progressive unilateral sensorineural hearing loss, tinnitus, and imbalance, but the presentation in the elderly population can be atypical, resulting in diagnostic delays. Here, we describe a septuagenarian female who presented with recurrent dizziness and falls, diagnosed as VS, involving the left internal auditory canal. Neural and otogenic tumors are often overlooked causes of falls in the geriatric population, where dizziness and falls may be attributed to orthostatic hypotension, cardiovascular causes, or polypharmacy. However, early recognition is important, as timely neuroimaging helps with accurate diagnosis and management. MRI remains the gold standard modality. Management options range from observation to radiotherapy to surgical excision, with the choice depending on tumor size, patient comorbidities, and symptom severity. This case highlights the importance of heightened clinical suspicion and thorough evaluation, including early neuroimaging in elderly patients with recurrent falls and dizziness. A multidisciplinary approach involving neurology, neurosurgery, otolaryngology, and radiology ensures optimal diagnosis, treatment, and long-term follow-up.