[A case of acoustic neurinoma presenting as subarachnoid hemorrhage]

A case of acoustic neurinoma presenting with subarachnoid hemorrhage is reported. The patient, a 33-year-old female, had suffered from left hearing disturbance and tinnitus for several years prior to admission. She had sudden onset of severe headache in the left posterior auricular region, nausea and vomiting while watching a play-going. Immediately she was brought to a neighboring hospital by ambulance. Lumbar puncture demonstrated xanthochromic cerebrospinal fluid with high opening pressure of 380 mmH2O or more and she was diagnosed as having subarachnoid hemorrhage (SAH). As her level of consciousness was progressively lowered, she was transferred and admitted to our hospital. Findings of plain CT scan on admission suggested that she had a brainstem hemorrhage with acute obstructive hydrocephalus. After the immediate operation of ventricle drainage, she became alert. Two weeks after admission, contrast-enhanced CT scan, internal meatus tomography and vertebral angiography were performed because she complained of tinnitus and hearing loss of her left ear. A huge lt. C-P angle tumor was revealed and its total removal was carried out successfully after V-P shunt operation for her hydrocephalic condition. Histological examination showed a typical acoustic neurinoma. The postoperative course was uneventful only with a moderate facial paresis on her left side. Acute and severe subarachnoid hemorrhage of the posterior fossa in cases of acoustic neurinoma has been reported very sporadically. However, CT examination revealed such a rare case of acoustic neurinoma and lead us to a successful surgical treatment for the patient.