<prompt> The first clinical presentation of acoustic neuroma is feature of ___Brainstem involvementCerebellar involvementFacial nerve involvementCochleovestibular symptoms  <response>: The earliest symptoms of acoustic neuromas include ipsilateral sensorineural hearing lossdeafness, disturbed sense of balance and altered gait, veigo with associated nausea and vomiting, and pressure in the ear, all of which can be attributed to the disruption of normal vestibulocochlear nerve function. Additionally more than 80 of patients have repoed tinnitus. 