Temporal lobe lesion

dear sir/madam
i'm a thai medical student, first year in clinic.
i have a 31 male patient who presented with headache on the left side, usually in the morning,
and usually had a vomiting for 3 months.
on the interview and physical examination told that he has a visual impairment of the right eye.
he had an aphasia which can be explaned that he understand what he had listened but when he speaked, he had swap the words and cannot made good sentences, but he can concentrate on what topic he was speaking. this symptom is occured when he had so mush headache only. and he told that he cannot understand TV series easily too.

no underlying disease, no history of trauma.

Full EOM
VA: finger count for 1.5 ft for right eye and 20/20 for left eye
VF: impair visual feild in the medial side of right eye and mild on temporal side of left eye.
numbness on his left side face and mild half lower left facial palsy. motor of CN 5 is normal
little weakness on left side extremities. motor power grade iv/v on left arm.

on MRI, showed that he had an arachnoid cyst on the pole of left temporal lobe. i think i understand what happened to his speaking and understanding, but not the visual field impairment and weakness of his left extremiteis.

Thanks for your explanation

[Michael Lim, MD]

In general, arachnoid cysts are usually benign lesions and usually are long-standing.  The symptoms of your patient may not be related to the cyst.  However if the cysts is causing mass effect or T2 changes, perhaps the thought of an arachnoid cyst as the original diagnosis should be revisited.  Otherwise, I would suggest getting input from a neurologist to help you with a further workup.