Tumor of the skull, palinopsia, depersonalization

[Rob2008]

I'm a 31 yr old male,  3 years ago I was diagnosed with fibrous dysplasia of the frontal skull bone after developing a continuous headache.  

For reference purposes,  I posted my MRI images here:

http://robsaysrelax.googlepages.com/

My doctors have a strict aversion to operating for this due to it being non-life threatening, as the tumor is stable.... however I have a continuous headache in the front of my head and  it's being suggested that I be prescribed bisphosphonates (Reclast) for symptom relief.  

I have also recently been experiencing what I believe to be "palinopsia",  or seeing tracers of light follow my vision from light sources when I look away,  however the rest of my brain is normal on the MRI and my doctor does not know why I have this symptom.

I do not know if I have mental symptoms, but I do have a diagnosis of "derealization and depersonalization".  Sometimes I wonder what effects the brain compression in this region has on me,  albeit according to my doctor a mild compression only to the brain.


I don't ask you to diagnose or give medical advice,  but is there any general comments that you can tell me about what you see in the images?  
Do you know anything about bisphosphonates?
Do you know if depersonalization can be a symptom of a tumor in this area?

[Rob2008]

Thank you for your kind response.  It is very appreciated.

[Abhijeet Deshmukh, MD]

Hello.

From the images, it is difficult to say if the dysplasia is pressing on the prefrontal cortex. The cortex outline appears to be well preserved. Given the fact that the growth is stable, I do not suspect it is pressing on the brain. But if it is, it will mostly be the orbitofrontal part of the prefrontal.

There is some evidence which suggests the prefrontal cortex (dorsolateral prefrontal cortex) may be involved in the "increased alertness" of depersonalization. But since derealization and depersonalization are regarded primarily as symptoms of anxiety, it will need some strong evidence to prove otherwise. And I suppose we do not have such an evidence yet. We do have some more evidence that organic brain diseases do cause these symptoms. But most of them do not mention frontal lobe or prefrontal cortex as a direct association.

The headache, however, does appear to be related to the dysplasia. A feeling of pressure on the frontal part of the head is commonly described. It is mostly due to the increased metabolism at the site.

Bisphosphonates are meant for symptomatic relief. They help prevent further damage to the bone structure. Just be careful about any dental procedure before starting bisphosphonates. There is good evidence for the beneficial effects of bisphosphonates in monostotic fibrous dysplasia.

There are chances of bleeding if fibrous dysplasia is associated with a bone cyst formation. Fibrous dysplasia is itself a rare bone tumor. It needs to be extensive and with bone cysts, for bleeding to occur (as per some studies).

You have also mentioned about palinopsia. I have personally seen only one patient who complained of palinopsia. The person was suffering from chronic mental health issues.

I did try to look for recent evidences for palinopsia as a symptoms of bone tumors in the skull. But there is no conclusive evidence. This does not mean they are not correlated. An ophthalmologist's response will be more valuable than mine.

Please note that I am not a Neurologist or a Radiologist. Since this is not a Neuro Experts' forum, and since you have mentioned derealization and depersonalization as two of your symptoms, I feel I could put some comments in. I do hope some Neurology experts are able to throw more light on this, particularly what you should expect in future from the bisphosphonate treatment and about palinopsia.  

Regards

Abhijeet Deshmukh, MD

[Bridget A. Hewitt, RN]

The MD at Medhelp is unable to answer your question.  Good luck.

[Rob2008]

Also, I don't know if you read these responses,  but I was also wondering if you could explain what it is that I feel in terms of my pressure headache.  Is it benign bone pain,   increased blood pressure in the head, etc,  and can I have a brain bleed from this tumor?

[Rob2008]

PS-  in regards to the palinopsia,   naturally I have also had an eye exam which was normal as well