Question Title: MRI abnormality/ seizure

Six weeks ago I had my first generalized convulsive seizure (while sleeping)
A CT scan showed nothing, a MRI showed a 1cm x 0.5cm CSF appearing
object in my right temporal lobe which could be an arachnoid cyst,
epidermoid, or low-grade neoplasm such as gangliglioma, according
to the radiologist.
Starting a couple of years ago I started to notice slight changes in
my speech, mostly in that I will substitute the wrong word while speaking.
Several questions arise: even though this "object" is in my non-dominant
lobe, could it be causing the speech change? Can such a small tumor
or cyst cause a grand mal seizure (I've never had any other types
of seizures) The radiologist noted there is no midline shift, mass
effect, or edema. My neurologist doesn't seem worried and says "its
probably just a cyst and nothing to worry about". I'm thinking
it's quite a coincidence that I have the speech problem and a seizure,
and my MRI shows an unidentified object in my temporal lobe.
Is there any speech function in the non-dominant lobe, and is
the "dominant lobe" ever switched to the other side?
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Dear Jason,

You questions are very perceptive. The new onset of seizures in a patient
beyond childhood should be investigated completely. The lesion you describe
on MRI could be a cyst alone or it could be associated with a tumor. Other
things that would signal a tumor (but not necessarily present in your case)
would be enhancement with gadolinium contrast and an intraparenchymal location.

Your speech difficulty is a bit unusual. Typically patients do not have difficulty
with speech when a lesion is present in the non-dominant temporal lobe (usually
the right side). Patients can, however, have bilateral speech localization at
times so your symptoms aren't out of the realm of possibility. Also the speech
difficulty could be due to subclinical seizure activity.

The fact that you had a generalized seizure does not offer so much information.
You could have had a focal seizure that spread and secondarily generalized,
which is common. The most pertinent question is why did you have a seizure.
Arachnoid cysts do not cause seizures, but tumors commonly do. This is not
meant to alarm you, only to let you know it needs to be investigated.

The first issue is to treat the seizures, which probably has been done already.
Dilantin is usually the first choice of medication. Second you should see
a good neurologist or a neurosurgeon for an evaluation. It is conceivable
that you have a low grade tumor causing seizure activity. Sometimes surgery
can be curative for these tumors.

You may choose to be seen at the Cleveland Clinic by calling 800-223-2273,
ask the operator for the neurosurgery clinic.

Good luck.

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