With Regard to the Brainstem, Size Matters Most

The differential diagnosis for an enhancing lesion in the cerebellopontine angle includes vestibular schwannoma, metastasis, meningioma, lymphoma, or glioma. However, in an adult with a history of progressive hearing loss, the radiographic features of this lesion—a homogeneous enhancement pattern, classic "ice cream cone" appearance as the lesion grows medially with extracanalicular extension, and intracanalicular widening to create the so-called "trumpet sign"—are pathognomic for vestibular schwannoma.

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