Acoustic neuroma commonly arises from inferior vestibular nerve

Acoustic neuroma commonly arises from inferior vestibular nerve and compresses cochlear nerve causing sensorineural hearing loss and tinnitus.

It is the most common cerebellopontine angle tumour followed by meningioma.

If acoustic neuroma still grows in size, it comes out from inner end of canal and occupies the cerebellopontine angle.

Here, it starts compressing the surrounding cranial nerves present – V cranial nerve first, then VII cranial nerve followed by XI & X cranial nerves.

Hence symptoms also arise in the same order.

Corneal sensation decreased (1st sign of V CN involvement) and numbness of face are related to V cranial nerve.

Lacrimation (diagnosed by schirmer test), Loss of taste (diagnosed by electrogustometry) and hitselberger sign (hypoesthesia of posterior meatal wall) are related to facial (VII) nerve.

Dysphagia and hoarseness are related to IX & X.

Hitselberger sign is the 1st sign that indicates facial nerve involvement.
Still expansion of tumour compresses cerebellum and causes related symptoms – ataxia, intention tremors, past-pointing, dysdiadochokinesia, etc…

Furthermore expansion will compress cerebral ventricles and cause raised intracranial tension – headache, nausea, vomiting, diplopia, papilloedema, etc…