**Question:** Acoustic neuroma causes the following except-

A. Facial nerve palsy
B. Sudden hearing loss
C. Vertigo
D. Tinnitus

**Core Concept:** Acoustic neuroma is a benign tumor that develops from the Schwann cells surrounding the eighth cranial nerve (vestibulocochlear nerve). It is primarily associated with neurofibromatosis type 2 (NF2), a genetic disorder. In this case, the correct answer will be related to a symptom or sign that is not typically caused by an acoustic neuroma but rather by another condition.

**Why the Correct Answer is Right:** Facial nerve palsy (A) is a more common complication of acoustic neuroma, especially when the tumor is large. Facial nerve palsy usually occurs due to compression or invasion of the facial nerve by the tumor.

**Why Each Wrong Option is Incorrect:**

B. Sudden hearing loss (B) is not a typical symptom of acoustic neuroma. Hearing loss in acoustic neuroma cases is generally progressive and asymmetric. Sudden hearing loss is usually caused by vascular disorders, labyrinthitis, or sudden noise exposure.

C. Vertigo (C) is a common symptom of vestibular neuritis, labyrinthitis, Meniere's disease, or benign paroxysmal positional vertigo (BPPV) rather than acoustic neuroma. Acoustic neuroma-induced vertigo is typically progressive and associated with tinnitus and hearing loss.

D. Tinnitus (D) is a common symptom of acoustic neuroma, as it occurs due to compression or invasion of the seventh cranial nerve (vestibulocochlear nerve) by the tumor.

**Clinical Pearl:** Acoustic neuroma is a potential cause of multiple symptoms related to cranial nerves VIII, VII, and IX, including hearing loss, tinnitus, and facial nerve palsy. Evaluation and management of these symptoms should be addressed as part of a comprehensive neurological examination.

**Correct Answer:** Sudden hearing loss (B) is the least likely symptom associated with acoustic neuroma, making it the correct answer option. This helps students to recognize the typical clinical presentation of acoustic neuroma and differentiate it from other conditions causing similar symptoms.