Large Sporadic Vestibular Schwannoma Causing Brainstem Compression and Obstructive Hydrocephalus in a Young Adult

Sporadic vestibular schwannomas are typically slow-growing, unilateral cerebellopontine angle benign tumors that occur in middle-aged and older adults and rarely present in individuals younger than 30 years. We describe the case of a 21-year-old man who presented with progressive unilateral hearing loss and tinnitus and was found to have a large vestibular schwannoma causing brainstem compression and obstructive hydrocephalus. Tumor analysis demonstrated a somatic mutation in neurofibromatosis type 2 (NF2), confined to the tumor, supporting a diagnosis of sporadic vestibular schwannoma in the absence of NF2 features. This case highlights the importance of early neuroimaging in patients with persistent or progressive unilateral audiovestibular symptoms.