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Neurology (Expert Forum)
visual problems and pineal cyst
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visual problems and pineal cyst
by ingcam, Oct 07, 2006 12:00AM
I have been experiencing some visual problems mainly blurred vision/difficulty focusing and transient double-vision. MRI revealed 17mm complex pineal cyst that abuts my tectum but without hydocephalus. This cyst uptakes gadolineum and compared to MRI 1yr prior has increased in size by 5mm diameter. The cyst does show some peripheral calcifications, however. I have had a posterior fossa craniectomy for cp angle cyst fenestration (rt. side) in oct 02 which was 25mm diameter and enlarging. I have nystagmus to the left and lower extremity hyperreflexia. I have c5-6 HNP found on MRI a few years ago (no recent c-spine MRI) I have little pain with this but do feel like my arms are heavier and clumsier mostly in the morning. My left leg feels a little weaker with some transient numbness in the lateral aspect of my foot. my questions are 1)If the pineal cyst uptakes gadolineum does this mean the the cyst is non-loculated vs. loculated 2)could my visual symptoms be caused by the cyst even though no hydrocephalus present? 2)the cyst is documented as "complex" and most likely benign but could this be a cystic tumor? 3)if my MRI is otherwise normal could my c5-6 disc herniation be causing my arm/leg issues? If re: cord issues wouldn't I have hyporeflexia? and what tests do you recommend to determine the causation of my arms/leg issues?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Oct 15, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The majority of pineal cysts are an incidental finding on MRI scans and have no clinical significance. However, some cases do invlove an enlarging cysts or a pineal tumor, and need to be excised. If your cyst indeed has grown 5mm in the past year and your are having new double vision and nystagmus, then I would recommend a consulation with a neurosurgeon for possible removal. The enhancement with GAD contrast signifies that the blood-brain barrier is broken down (no relationship to loculations). This can be due to tumor, cyst expansion, inflammation etc.
The symptoms you describe in the arms/legs are not likely to be caused by the pineal cyst (only the double vision and nystagmus is likely related). I would suspect your c-spine as the cause of your arm/leg symptoms. To confirm this I would suggest an EMG and a SSEP (somatosensory evoked potential. Cord lesions cause hyporelexia-only when they involve the alpha motor neuron. Your C-spine compression sqeezes the axons on their way form the cortex (central control of muscle), which then causes hyper reflexia and somtimes weakness.
I hope this has been helpful.
The majority of pineal cysts are an incidental finding on MRI scans and have no clinical significance. However, some cases do invlove an enlarging cysts or a pineal tumor, and need to be excised. If your cyst indeed has grown 5mm in the past year and your are having new double vision and nystagmus, then I would recommend a consulation with a neurosurgeon for possible removal. The enhancement with GAD contrast signifies that the blood-brain barrier is broken down (no relationship to loculations). This can be due to tumor, cyst expansion, inflammation etc.
The symptoms you describe in the arms/legs are not likely to be caused by the pineal cyst (only the double vision and nystagmus is likely related). I would suspect your c-spine as the cause of your arm/leg symptoms. To confirm this I would suggest an EMG and a SSEP (somatosensory evoked potential. Cord lesions cause hyporelexia-only when they involve the alpha motor neuron. Your C-spine compression sqeezes the axons on their way form the cortex (central control of muscle), which then causes hyper reflexia and somtimes weakness.
I hope this has been helpful.
Member Comments (2)
by lil mamma, Oct 21, 2006 12:00AM
I have a pineal cyst in my brain.I found this out about nine years ago. I was having severe headaches ad the doctors thought that they may be in my imagination. I kept going to different doctors untill I found one who ran some test right awat and found the cyst. It Is very large. When my headaches get geally bad, my right eye lid droopd or sometimes shuts comeplely for up to three days. I have been told thad I could have been born with it or I could have had it for 30 years. I am 42 years old now. I hope this helps someone.
