Arachnoid cyst with visual impairment

[NeuroSurg]

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 and 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

[dr_simran]

Hello Dear,
Arachnoid cysts are cerebrospinal fluid-filled sacs that are located between the brain or spinal cord and the arachnoid membrane, one of the three membranes that cover the brain and spinal cord Secondary arachnoid cysts are not as common as primary cysts and develop as a result of head injury, meningitis, or tumors, or as a complication of brain surgery.  The majority of arachnoid cysts form outside the temporal lobe of the brain in an area of the skull known as the middle crania fossa.  Arachnoid cysts involving the spinal cord are rarer.  The location and size of the cyst determine the symptoms and when those symptoms begin.
Typical symptoms of an arachnoid cyst around the brain include headache, nausea and vomiting, seizures, hearing and visual disturbances, vertigo, and difficulties with balance and walking.The weakness of extremities could be due to pressure over the spinal cord.A MRI should be done to rule out the presence of another cyst in the spine.

Refer http://www.medhelp.org/posts/show/567545
Best

[NeuroSurg]

****VA: finger conut 1.5 for right eye, normal for left eye