Acute severe headache associated with rapid tumor growth in a patient with vestibular schwannoma.

PURPOSE Although headache in vestbibular schwannoma (VS) is uncommon as an initially presenting symptom, headache in VS is usually associated with tumor growth due to various factors, especially abrupt increase in size. We discuss various factors which influence rapid tumor growth including intratumoral hemorrhage and cystic change of tumor. CASE REPORT A 68-years old female presented with sudden acute onset of occipital headache and severe dizziness. Brain MRI revealed 28 x 18 x 22 mm sized vestibular schwannoma with cystic change and heterogeneous enhancement (intratumoral hemorrhage) in the left cerebellopontine cistern with intracanalicular extension. CONCLUSION This is a rare case of vestibular schwannoma with cystic change due to intratumoral hemorrhage with atypical apoplectic presentation on the background of hearing loss of 3 year duration. This highly unusual case highlights the need for careful clinical and radiological follow-up, in patients with vestibular schwannoma. In addition, although the predictive value may be limited, we must keep in mind that acute severe headache may be an alarming feature that predicts rapid tumor growth.