intractible headache, diplopia, intra osseous tumor

[charlie c]

Im a nursing student and friend of a prev poster. about his orbital lesion, intractable widespead frontal headache, tension in forehead, and diplopia with eye movements. He said he couldn't post again, some reason. What has brought confusion into the scene is that a neuro and ENT are giving him Elavil and telling him the symptoms are unrelated.
Please see MRI images, tell me your opinion, and recommend a Dr. to see at CCF for opinion #2(you?)

ax T2 FSE FS:
http://img88.imageshack.us/my.php?image=axt2fsefs0012mv4.jpg
http://img81.imageshack.us/my.php?image=axt2fsefs0013zq8.jpg
http://img90.imageshack.us/my.php?image=axt2fsefs0014oq2.jpg
http://img56.imageshack.us/my.php?image=axt2fsefs0015rs6.jpg

Ax Flair:
http://img84.imageshack.us/my.php?image=axflair0012sn9.jpg
http://img84.imageshack.us/my.php?image=axflair0013iv0.jpg
http://img87.imageshack.us/my.php?image=axflair0014ug4.jpg
http://img209.imageshack.us/my.php?image=axflair0015pf4.jpg

Ax T1 FS Post Contrast:
1) http://img83.imageshack.us/my.php?image=axt1fspostcontrast0011er1.jpg
2) http://img209.imageshack.us/my.php?image=axt1fspostcontrast0012nv5.jpg
3) http://img89.imageshack.us/my.php?image=axt1fspostcontrast0013il0.jpg
4) http://img212.imageshack.us/my.php?image=axt1fspostcontrast0014ws0.jpg
5) http://img209.imageshack.us/my.php?image=axt1fspostcontrast0015hh4.jpg

Also was wondering, is pain from a tumor like this usually benign pain or is a risk for aneurysm? He has also complained of hearing a "squishing" from occipital area when he moves his head and pain at the cranio-cerv junction.

[CCF-Neuro-M.D.-SH]

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. Thank you for the additional images. They demonstrate that the tumor in the left supraorbital region is stronlgy contrast enhancing and appears extraxial (outside the brain itself), which suggest a meningioma (but not specific), but it will not be clear until the full study is reviewed (some cases require biopsy).  Due to the proximity of this lesion to the left orbit and the fact that your double vision is worse with eye movements suggests mass effect as previously discussed.  It is possible that this tumor is precipitating migraine headaches.  In this case elavil (as a migraine preventative medicine) would not be a bad choice, but I would not expect any benifit on the double vision.  The other issue that needs to be addressed is does this tumor need to be surgically removed?  That will not be known until your case is reviewed by neurologist and neurosurgeons.  Although from the information I have, I cannot tell you if your tumor is benign, but I can tell you the pain will not cause an aneurysm or other structural lesion.  As a first step I would see a neurologist that specializes in headache and that doctor will be able to direct your care from there.  I would recommend Dr. Mark Stillman at the headache center if you would like to come to the Cleveland Clinic.  It sometimes can take some time to get an appointment.  I will discuss what I know about your case with him.   I hope this has been helpful.