A RARE PRESENTATION OF BILATERAL VESTIBULAR SCHWANNOMAS

OBJECTIVE We report a rare presentation of bilateral vestibular schwannomas with left eye ptosis with ophthalmoplegia.CASE REPORT An 18 year old female patient was referred from Ophthalmology department to ENT department with one year history of left eye lid drooping and hard of hearing left ear. Pure tone audiogram showed left ear moderate SN hearing loss and right ear mild SN hearing loss. Brain Stem Evoked Response Audiogram showed wave III and wave V latency on both sides more on left side.Gadolinium enhanced MRI brain showed bilateral acoustic neuroma with neurofibromatous changes in the left eye retro orbital area with medial rectus hypertrophy.CONCLUSION Ptosis with ophthalmoplegia has rarely been reported in NF2. In our case described, left eye ptosis with ophthalmoplegia was caused by mechanical effect of mass in retro orbital area.In this case since the tumors on the both sides more than 1.5cm, the best option is regular follow up eventhough she had moderate hearing loss on the left side. Patient was advised for correction of left eye ptosis, but she was not concerned about it and deferred surgery. So she was advised regular follow up annually for clinical, audiological and radiological evaluation.