Suspecting Acoustic Neuroma On Clinical Signs...

A 45-year-old man presents with dizziness and right-sided hearing loss to his GP. Which one of the following tests would most likely indicate an acoustic neuroma?

A. Jerky nystagmus
B. Left homonymous hemianopia
C. Tongue deviated to the left
D. Fasciculation of the tongue
E. Absent corneal reflex

Answer:
E. Absent corneal reflex

Discussion: Loss of corneal reflex - think acoustic neuroma

Acoustic neuromas (more correctly called vestibular schwannomas) account for approximately five percent of intracranial tumours and 90 percent of cerebellopontine angle 

Clinical Features can be predicted by the affected cranial nerves 

 cranial nerve VIII: hearing loss, vertigo, tinnitus 

 cranial nerve V: absent corneal reflex 

 cranial nerve VII: facial palsy 

Bilateral acoustic neuromas are seen in neurofibromatosis type 2 

MRI of the cerebellopontine angle is the investigation of choice