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Eighth cranial nerve schwannomas are among the most common intracranial tumors Most are unilateral, but about 5% are associated with the hereditary syndrome, neurofibromatosis type 2, in which bilateral eighth nerve tumors may be accompanied by meningiomas and other intracranial and spinal tumors Although recent concern over the role of cell phones in the origin of these tumors has appeared in the popular press, the evidence of an association is in doubt These benign lesions arise within the internal auditory canal and gradually grow to involve the cerebellopontine angle, eventually compressing the pons and resulting in hydrocephalus Their typical auditory symptoms are unilateral hearing loss with a deterioration of speech discrimination exceeding that predicted by the degree of pure tone loss Nonclassic presentations, such as sudden unilateral hearing loss, are fairly common Any individual with a unilateral or asymmetric sensorineural hearing loss should be evaluated for an intracranial mass lesion Vestibular dysfunction more often takes the form of continuous dysequilibrium than episodic vertigo Other lesions of the cerebellopontine angle such as meningioma and epidermoids may have similar audiovestibular manifestations Diagnosis is made by enhanced MRI, although auditory evoked responses may have a role in screening Microsurgical excision is often indicated, although small tumors in older persons may be managed with stereotactic radiotherapy or simply monitored with serial imaging studies

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Betchen SA et al Long-term hearing preservation after surgery for vestibular schwannoma J Neurosurg 2005 Jan;102(1):6 9 [PMID: 15658089] Lunsford LD et al Radiosurgery of vestibular schwannomas: summary of experience in 829 cases J Neurosurg 2005 Jan;102 Suppl:195 9 [PMID: 15662809] Neff BA et al Current concepts in the evaluation and treatment of neurofibromatosis type II Otolaryngol Clin North Am 2005 Aug;38(4):671 84 [PMID: 16005725]

public static bool operator !=(Fraction lhs, Fraction rhs) { return !(lhs==rhs); }

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Central nervous system causes of vertigo include brainstem vascular disease, arteriovenous malformations, tumor of the brainstem and cerebellum, multiple sclerosis, and vertebrobasilar migraine Vertigo of central origin often becomes unremitting and disabling The associated nystagmus is often nonfatigable, vertical rather than horizontal in orientation, without latency, and unsuppressed by visual fixation ENG is useful in documenting these characteristics There are commonly other signs of brainstem dysfunction (eg, cranial nerve palsies; motor, sensory, or cerebellar deficits in the limbs) or of increased intracranial pressure Auditory function is generally spared The underlying cause should be treated

Baloh RW Episodic vertigo: central nervous system causes Curr Opin Neurol 2002 Feb;15(1):17 21 [PMID: 11796946] Seemungal BM Neuro-otological emergencies Curr Opin Neurol 2007 Feb;20(1):32 9 [PMID: 17215686]

DISEASES OF THE CENTRAL AUDITORY & VESTIBULAR SYSTEMS (TABLE 8 1)

As you can see, the != operator will return the opposite of the value of the == operator, which is exactly what you want. This way, if you change your definition of equality, you can change the code in the == operator overload, and the != operator will still return the opposite. Similarly, the less than (<) and greater than (>) operators must be paired, as must the less than or equal to (<=) and greater than or equal to (>=) operators. The Object class (which is the root of every class in C#) offers a virtual method called Equals( ). (We discuss virtual methods in 11.) If you overload the equals operator (==), it is recommended that you also override the Equals( ) method. Overriding the Equals( ) method allows your class to be compatible with other .NET languages that do not overload operators (but do support method overloading). That way, even if you can t use the == operator, you can still use the Equals( ) method to do the same thing. The Object class implements the Equals( ) method with this signature:

Lesions of the eighth cranial nerve and central audiovestibular pathways produce neural hearing loss and vertigo One characteristic of neural hearing loss is deterioration of speech discrimination out of proportion to the decrease in pure tone thresholds Another is auditory adaptation, wherein a steady tone appears to the listener to decay and eventually disappear Auditory evoked responses are useful in distinguishing cochlear from neural losses and may give insight into the site of lesion within the central pathways

Duration of Typical Vertiginous Episodes Seconds Hours Days Months Auditory Symptoms Present Perilymphatic fistula Endolymphatic hydrops (Meniere s syndrome, syphilis) Labyrinthitis, labyrinthine concussion Acoustic neuroma, ototoxicity Auditory Symptoms Absent Positioning vertigo (cupulolithiasis), vertebrobasilar insufficiency, cervical vertigo Recurrent vestibulopathy, vestibular migraine Vestibular neuronitis Multiple sclerosis, cerebellar degeneration

Schoemaker MJ et al Mobile phone use and risk of acoustic neuroma: results of the Interphone case-control study in five North European countries Br J Cancer 2005 Oct 3;93(7): 842 8 [PMID: 16136046] Yoshimoto Y Systematic review of the natural history of vestibular schwannoma J Neurosurg 2005 Jul;103(1):59 63 [PMID: 16121974]

public virtual bool Equals(object o)

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