Introduction: Ring chromosome 22 (r[22]) can lead to the development of intracranial tumors such as meningiomas, neurofibromas, and schwannomas similar to neurofibromatosis 2 (NF2). Case Presentation: An 18-year-old female with r(22) and a history of global development delay and cognitive impairment presented with sudden hearing loss. MRI revealed bilateral vestibular schwannomas. Given documented audiologic decline in the patient’s hearing, the larger tumor was treated with CyberKnife fractionated stereotactic radiosurgery, and the smaller tumor is being monitored. Conclusion: This case provides further evidence that patients with r(22) can develop clinical features of NF2, including the development of bilateral vestibular schwannomas, and should be monitored for hearing disturbances starting in puberty as a warning sign for these tumors.

1.
Mahajan
S
,
Kaur
A
,
Singh
J
.
Ring chromosome 22: a review of the literature and first report from India
.
Balkan J Med Genet
.
2012
;
15
(
1
):
55
9
. .
2.
Denayer
E
,
Brems
H
,
de Cock
P
,
Evans
GD
,
Van Calenbergh
F
,
Bowers
N
, et al
Pathogenesis of vestibular schwannoma in ring chromosome 22
.
BMC Med Genet
.
2009
;
10
:
97
. .
3.
Trofatter
JA
,
MacCollin
MM
,
Rutter
JL
,
Murrell
JR
,
Duyao
MP
,
Parry
DM
, et al
A novel moesin-, ezrin-, radixin-like gene is a candidate for the neurofibromatosis 2 tumor suppressor
.
Cell
.
1993
;
72
(
5
):
791
. .
4.
Agrawal
H
,
Mery
CM
,
Sexson Tejtel
SK
,
Fraser
CD
,
McKenzie
ED
,
Qureshi
AM
, et al
Familial clustering of cardiac conditions in patients with anomalous aortic origin of a coronary artery and myocardial bridges
.
Cardiol Young
.
2018
;
28
(
9
):
1099
105
. .
5.
Zirn
B
,
Arning
L
,
Bartels
I
,
Shoukier
M
,
Hoffjan
S
,
Neubauer
B
, et al
Ring chromosome 22 and neurofibromatosis type II: proof of two-hit model for the loss of the NF2 gene in the development of meningioma
.
Clin Genet
.
2012
;
81
(
1
):
82
7
. .
6.
Kehrer-Sawatzki
H
,
Udart
M
,
Krone
W
,
Baden
R
,
Fahsold
R
,
Thomas
G
, et al
Mutational analysis and expression studies of the neurofibromatosis type 2 (NF2) gene in a patient with a ring chromosome 22 and NF2
.
Hum Genet
.
1997
;
100
(
1
):
67
74
. .
7.
Tsilchorozidou
T
,
Menko
FH
,
Lalloo
F
,
Kidd
A
,
De Silva
R
,
Thomas
H
, et al
Constitutional rearrangements of chromosome 22 as a cause of neurofibromatosis 2
.
J Med Genet
.
2004
;
41
(
7
):
529
34
. .
8.
Celis-Aguilar
E
,
Lassaletta
L
,
Torres-Martín
M
,
Rodrigues
FY
,
Nistal
M
,
Castresana
JS
, et al
The molecular biology of vestibular schwannomas and its association with hearing loss: a review
.
Genet Res Int
.
2012
;
2012
:
856157
. .
9.
Aghi
M
,
Kluwe
L
,
Webster
MT
,
Jacoby
LB
,
Barker
FG
 2nd
,
Ojemann
RG
, et al
Unilateral vestibular schwannoma with other neurofibromatosis type 2-related tumors: clinical and molecular study of a unique phenotype
.
J Neurosurg
.
2006
;
104
(
2
):
201
7
. .
10.
Castellanos
E
,
Bielsa
I
,
Carrato
C
,
Rosas
I
,
Solanes
A
,
Hostalot
C
, et al
Segmental neurofibromatosis type 2: discriminating two hit from four hit in a patient presenting multiple schwannomas confined to one limb
.
BMC Med Genomics
.
2015
;
8
:
2
. .
11.
Evans
DG
,
Huson
SM
,
Donnai
D
,
Neary
W
,
Blair
V
,
Newton
V
, et al
A clinical study of type 2 neurofibromatosis
.
Q J Med
.
1992
;
84
(
304
):
603
18
..
12.
Knudson
AG
 Jr
.
Mutation and cancer: statistical study of retinoblastoma
.
Proc Natl Acad Sci U S A
.
1971
;
68
(
4
):
820
3
. .
13.
Evans
DG
.
Neurofibromatosis type 2 (NF2): a clinical and molecular review
.
Orphanet J Rare Dis
.
2009
;
4
:
16
. .
14.
Tommerup
N
,
Warburg
M
,
Gieselmann
V
,
Hansen
BR
,
Koch
J
,
Petersen
GB
.
Ring chromosome 22 and neurofibromatosis
.
Clin Genet
.
1992
;
42
(
4
):
171
7
. .
15.
Aslan
A
,
De Donato
G
,
Balyan
FR
,
Falcioni
M
,
Russo
A
,
Taibah
A
, et al
Clinical observations on coexistence of sudden hearing loss and vestibular schwannoma
.
Otolaryngol Head Neck Surg
.
1997
;
117
(
6
):
580
2
. .
16.
Rosahl
S
,
Bohr
C
,
Lell
M
,
Hamm
K
,
Iro
H
.
Diagnostics and therapy of vestibular schwannomas: an interdisciplinary challenge
.
GMS Curr Top Otorhinolaryngol Head Neck Surg
.
2017
;
16
:
Doc03
. .
17.
Magdziarz
DD
,
Wiet
RJ
,
Dinces
EA
,
Adamiec
LC
.
Normal audiologic presentations in patients with acoustic neuroma: an evaluation using strict audiologic parameters
.
Otolaryngol Head Neck Surg
.
2000
;
122
(
2
):
157
62
. .
18.
Myrseth
E
,
Møller
P
,
Wentzel-Larsen
T
,
Goplen
F
,
Lund-Johansen
M
.
Untreated vestibular schwannomas: vertigo is a powerful predictor for health-related quality of life
.
Neurosurgery
.
2006
;
59
(
1
):
67
76
.
discussion 67–76
. .
19.
Halliday
J
,
Rutherford
SA
,
McCabe
MG
,
Evans
DG
.
An update on the diagnosis and treatment of vestibular schwannoma
.
Expert Rev Neurother
.
2018
;
18
(
1
):
29
39
. .
20.
Maniakas
A
,
Saliba
I
.
Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years’ follow-up
.
Otol Neurotol
.
2012
;
33
(
9
):
1611
20
. .
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