In neurofibromatosis type 2, which screening test should be performed annually to monitor brain involvement?

• A. Eye exam
• B. EEG
• C. MRI of the brain
• D. CT scan of the chest

Answer: (C)

In neurofibromatosis type 2, the main concern is the development and progression of intracranial tumors, especially vestibular schwannomas and other CNS tumors. Magnetic resonance imaging of the brain with contrast provides the clearest, most sensitive view of soft tissue in the brain and posterior fossa, allowing detection of small tumors and accurate assessment of their size and location. Because tumors can develop or grow over time, an annual MRI brain is the most effective way to monitor brain involvement and guide management without exposing the patient to ionizing radiation. An eye exam can reveal ocular findings seen in NF2 but does not assess brain tumors; EEG measures brain electrical activity rather than anatomy; and a CT scan of the chest is not relevant to monitoring CNS involvement.