A Rare Presentation of Trigeminal Schwannoma with Extensive Multiple Cranial Nerve Palsies: a Case Report

Background: Trigeminal schwannoma is benign tumor arising from the Schwann cells of the trigeminal nerve1. While their clinical presentation typically involves trigeminal nerve dysfunction2, extensive involvement leading to multiple cranial nerve palsies is a less common occurrence, particularly as the initial presenting feature3. We report a rare case of a 47-year-old female presented with history of right-sided ptosis, headache, and earache since 4-months. Imaging studies revealed a large trigeminal schwannoma (40x34x22 mm) extending into the posterior cranial fossa and cavernous sinus, resulting in compression of multiple cranial nerves. This case highlights the atypical and potentially misleading initial symptoms of a large trigeminal schwannoma and emphasizes the importance of considering intracranial lesions in patients with seemingly isolated cranial nerve deficits. We discuss the clinical presentation and diagnostic findings in such rare and complex cases, along with a review of relevant literature.