# When Falls Reveal More: The Geriatric Giant Unveils a Vestibular Schwannoma

## TL;DR

An elderly woman with recurrent falls and dizziness was diagnosed with a vestibular schwannoma, highlighting the need for early imaging in atypical cases.

## Contribution

This case emphasizes the importance of considering vestibular schwannomas as a cause of falls in the elderly, often misattributed to other conditions.

## Key findings

- Vestibular schwannomas can present as dizziness and falls in the elderly, leading to diagnostic delays.
- MRI is the gold standard for diagnosing vestibular schwannomas.
- A multidisciplinary approach is essential for optimal management of elderly patients with vestibular schwannomas.

## Abstract

Vestibular schwannomas (VSs) are benign tumors originating from Schwann cells of the vestibular component of the eighth cranial nerve. They classically present as progressive unilateral sensorineural hearing loss, tinnitus, and imbalance, but the presentation in the elderly population can be atypical, resulting in diagnostic delays. Here, we describe a septuagenarian female who presented with recurrent dizziness and falls, diagnosed as VS, involving the left internal auditory canal. Neural and otogenic tumors are often overlooked causes of falls in the geriatric population, where dizziness and falls may be attributed to orthostatic hypotension, cardiovascular causes, or polypharmacy. However, early recognition is important, as timely neuroimaging helps with accurate diagnosis and management. MRI remains the gold standard modality. Management options range from observation to radiotherapy to surgical excision, with the choice depending on tumor size, patient comorbidities, and symptom severity. This case highlights the importance of heightened clinical suspicion and thorough evaluation, including early neuroimaging in elderly patients with recurrent falls and dizziness. A multidisciplinary approach involving neurology, neurosurgery, otolaryngology, and radiology ensures optimal diagnosis, treatment, and long-term follow-up.