one more question

[sequal9]

This is a follow-up from my post the other day:
http://www.medhelp.org/posts/Neurology/Strange-feeling-in-head/show/1284911

Over the past 5 yrs. since I developed chronic headache, I've become pretty apathetic about discussing this, but I found it quite irresistible to follow up since you mentioned a meningioma even when I said my MRI was normal.   Originally, I told you my brain MRI last summer was normal.  But that's not entirely true..it's totally normal, except for a 3.4 x 2.3 cm bone mass in the frontal bone.  I posted one of my MRI's online,please look:

http://sites.google.com/site/robsaysrelax/

My head has been scanned 3 times by MRI and 5 times by CT, and the mass has never changed, since it was found in 2005.  I started having a continuous dull pressure in my head back then... but even though my headache is frontal, it's not particularly localized to the left area,  and doctors mostly told me it wasn't causing my headache... but  I see an ENT surgeon at a major University now who thinks it is causing my symptoms, and he told me he didn't want to operate but he would if I couldn't stand the symptoms anymore.

He thinks that it's Fibrous dysplasia. Of course, I will observe the standard "only take the advice of my personal physician" but I would really be interested to know what your overall general opinion is.  (By the way, can I develop an acute or sub-acute pathology as a result of this lesion?)

To recap:
1)  continuous dull frontal head pressure x 5 years.... it often throbs and increases in intensity for 10 seconds when I first stand up. Feels better when I put pressure on my forehead with my hand.

2)  frequent migraine like headaches in the same area

3)  the rubbery stiff feeling in my forehead muscles (always there)

4)  the odd sensations occasionally in my nose/mouth

5)   Severe, but not total loss of smell, swollen turbinates, pressure feeling in my nose especially when laying down or bending over forward.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Fibrous dysplasia can be of several forms – monostotic (i.e., single bone involvement) or polystotic (i.e., multiple bony involvement). Symptoms depend on the location of the lesion. Since your lesion is in the left frontal region, it quite possibly be the cause of your headaches if the mass effect is large enough to put pressure on pain sensitive regions such as vessels or one of the linings around the brain. These lesions make the bone more fragile. Rarely do they result in another type of tumor, but cases have been documented.

It does not sound like you have migraines. You mention a frontal dull headache that throbs with standing. Just by this description, it does not sound like a migraine. There are multiple other types of head pains. One that is postural in origin (i.e., worsen with standing) that never improves can be from low CSF pressure. If you have had multiple MRIs that do not show leptomeningeal (i.e., tissue surrounding the brain) enhancement, this type of headache is unlikely. The fibrous dysplasia, if that is what it is (only biopsy can tell definitively) can be the source of your symptoms. I recommend that you continue following up with your ENT. It may be worthwhile to have an opinion from a neurosurgeon. If no surgery is indicated, a follow up to a headache specialist would be of benefit.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[sequal9]

PS-  While I'm at it, I might as well also mention that I get tingling/crawling sensations around my scalp,  also.  Not necessarily frequently, though, I definitely it.

[sequal9]

PS -  Needless to say, I thank you 200% for your time, your response means more than you probably realize