2nd MRI or biopsy?

  Hi,
    This is my second question, thanks for answering.
  I am a 40 yr old female who recently went to the ER because of a
  severe headache accompanied by uncontrolled high blood pressure 180/130.
  I was treated for the BP with procardia which brought it down to normal
  range. They were unable to help the headache even with IV morphine, but
  after I vomited the headache eventually subsided to tolerable levels.
  The ER doctor wanted to rule out an aneurysm so she ordered a CT scan which
  came back abnormal, then ordered an MRI which also came back abnormal.
  A neuruologist was called in and he told me he felt it was a tumor. A
  neurosurgeon was called in and he wasn't as sure it was, said it could be
  scar tissue or just the way I was born. I've since had an EEG which came
  back normal and an LP which of the tests that have come back (all but
  cultures) all are normal. I have no symptoms of a BT (slurred speech,
  dizziness, double vision) except possibly increased headaches which for the
  most part I would consider mild to moderate.
    
   The neurosurgeon gave me two options 1. wait three months and have another
  MRI or 2. have a biopsy done (sounded too scarey), so I opted for the wait.
    Now after doing some research and learning a few things about BT I'm
  beginning to wonder if I made the right decision of waiting. If I go back
  in 3 months for 2nd MRI and there is no change, is that the end? Am I
  guaranteed there is no tumor that it's just "something else"? Do the normal
  EEG and initial LP tests rule out a BT? Why would the neurologist suspect
  a brain tumor? What are the chances of having a BT without symptoms?
    Would you suggest a biopsy or waiting for 2nd MRI?
  Thanks for any answers   :o)  
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Thanks for your question.  The most important element to provide a complete
input to your question is, unfortunately, missing, namely the MRI scan.
Depending on its size, location, radiographic texture/homogeneity, the
aspect of its boundaries where it transitions to normal brain tissue one
can reach reasonable conclusions about a brain "mass".  Another very
important aid for "tumor diagnosis" is the use of contrast medium during
the imaging study (e.g. gadolinium in the case of MRI scans).  A significant
number of tumor types will "enhance" (become "brighter") with a contrast
medium.  I am assuming that the conservative approach adopted by your
neuro-surgeon was based on the LACK of "aggressive" features in the mass,
such as indistict "mass" boundaries, significant tissue edema, heterogeneities
suggestive of bleeding into the mass, lack of enhancement with contrast.
Furthermore, the location of the "mass" (whether it is deep or superficial)
would also significantly change the risk of biopsy complications (such as
lesion to other brain structures, bleeding, etc.).  As I mentioned above,
without the actual imaging studies, it is very difficult to provide an
informed opinion.
If you are interested in a second opinion, and are near the Cleveland area,
the Departments of Neurology and Neurological Surgery at the Cleveland
Clinic has a group of Neurologists (Drs. Cohen, and Stevens) and Neuro-surgeon
(Dr. Barnett) who are specialized in Neuro-Oncology and Neuro-Oncology
surgeries.
If you would like to make an appointment at the Dept. of Neurolgy
please call 1-216-444-5559 or 1-800-CCF-CARE.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.