• Chief complaint: A 34 year old female presents with bilateral partial hearing loss. 

    HPI: Further questioning reveals increasing bilateral upper extremity paresthesias and increasingly dropping items with left hand. Also noted gradual onset swallowing difficulties and increased frequency of hiccups. 

    ROS: negative except as noted in HPI 

    Past medical and surgical history: negative 

    Family history: negative 

    Medications: none 

    Alert and oriented X 3 CN exam 
    Audiology: Right - Gardner Robertson grade 2; Left - Gardner Robertson grade 3 
    Swallow evaluation / oropharyngeal movements WNL 
    Sensation intact to light touch and pin-prick 
    Strength 5/5 in all muscle groups bilaterally 
    Deep tendon reflexes - 2+, symmetric 
    No pathologic reflexes

    Figure 1. T2-weighted and post contrast T1-weighted contrast-enhanced MR-images reveal bilateral cerebellopontine angle masses.

    Figure 2. T2-weighted and post contrast T1-weighted contrast-enhanced MR-images reveal a contrast enhancing lesion within the cord (c2-3) associated with a rostral and caudal peri-tumoral cyst cavity lined by hemosiderin.

    1. The patient is most likely to be diagnosed with which condition?

    2. What is the most likely etiology of dysphagia and hiccups in this patient? (choose one)

    3. What would you recommend as the first course of action for this patient?

    4. When performing surgery for intramedullary spinal cord tumors:

    5. The approach I am most likely to use for this patient with regards to management of the bilateral CPA masses is:

    6. Which of the following describes you?

    7. I practice in one of the following locations.

    8. Please add any suggestions or comments regarding this case:

    • Good test
    • This is a great case for discussion. I felt last month's case on Type II Odontoid Fracture was just too easy & straight-forward, could be answered by a junior resident, and didn't really merit "Case of the Month". Glad we have a more thought-provoking case for this month!
    • thank alot for your effort for better future for all of us.
    • surgery fore c1-c2 , with decompresion of posterior fossa up to sinus
    • i do spinal tumor resection ,then left cp angle and do radio surgery for rt cp angle tumor
    • Very interesting, challenging case!

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