MRI Evaluation of Neurofibromatosis Type 2 in a Young Female with Vestibular Schwannoma and Multiple Meningiomas: A Case Report

Abstract

Neurofibromatosis Type 2 (NF2) is a rare autosomal dominant neurocutaneous disorder characterised by the development of multiple central nervous system tumours, particularly vestibular schwannomas and meningiomas. Magnetic Resonance Imaging (MRI) plays a crucial role in early detection and surveillance of these lesions. A 22-year-old female presented with progressive hearing loss in the right ear for five months and intermittent headache. Pure tone audiometry revealed moderately severe sensorineural hearing loss in the right ear. MRI brain demonstrated a right cerebellopontine angle extra‑axial mass extending into the internal auditory canal. The lesion appeared T2/FLAIR hyperintense, showed no diffusion restriction, demonstrated few blooming foci on susceptibility weighted imaging, and showed homogeneous postcontrast enhancement. The patient subsequently underwent surgical excision of the lesion, and histopathological examination of the excised specimen confirmed schwannoma. Additionally, two lesions consistent with meningiomas were identified. The first was an extra‑axial lesion in the left parietal region which appeared heterogeneously hyperintense on T2/FLAIR. The second lesion was a calcified lesion located in the temporal horn of the right lateral ventricle, appearing hypointense on both T1 and T2/FLAIR sequences and demonstrating blooming on susceptibility-weighted imaging without diffusion restriction. The co-existence of vestibular schwannoma with multiple intracranial meningiomas raises suspicion for neurofibromatosis Type 2. MRI plays a key role in detection and follow‑up of patients with suspected NF2.