Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 3, 2011
Trochlear Schwannoma with Superior Oblique Atrophy
- Trochlear schwannoma is a rare cause of superior oblique muscle palsy.
- It is a benign, extremely slow growing tumor with a good prognosis.
- Key Diagnostic Features: Schwannomas have a characteristic MRI appearance. On T1-weighted images they are usually isointense or slightly hypointense compared to gray matter. On T2-weighted images they are slightly hypointense to CSF. Smaller schwannomas usually enhance homogeneously with gadolinium, but as they grow larger they can become heterogenous. Often, trochlear schwannomas are observed along the cisternal portion of the nerve. Superior oblique atrophy may be noted.
- DDx: Meningioma, Metastases, Lymphoma, Leukemia
- Rx: Unless brainstem compression develops, patients with these tumors generally do not need neurosurgery. Diplopia can be corrected with prism spectacles or strabismus surgery and patients can simply be followed with serial MRI scans.
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