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Forum Name: Neurology Topics

Question: What is a sublenticular cyst? (And other questions)


 Trent85 - Fri Jul 23, 2010 2:02 pm

Hello Doctors Lounge readers. This is my first post as I just recently came across your site and noticed this community. I hope that someone may be able to help me out as I am dealing with a 2+ year long journey of ongoing symptoms that have yet to be diagnosed.

As of recent I had an MRI/CT Scan done of my brain for these symptoms (those being an increasingly worse amount of memory loss, confusion, disorientation (as of late), perpetual fatigue/weakness/malaise/tiredness, sensory aversion (loud signs/bright lights/etc.), and even as of late, potential fibromyalgia, among a few others. These symptoms have been getting worse for over the past two-three years of my life and have been a huge detriment. I have had to forgo completing my Bachelor's degree, I am now living with my parents again (25 year old, single male), I can not concentrate or remember things I read or do just days or the day before and even has affected long term memory), I'm working the minimum amount at a very low end job (waiting tables) just for the specific purpose of keeping my health care, which is good because it allows me to forgo referrals for any specialist in my network.

With the preamble, I've seen countless Doctors and Specialists (allergists, pulmonologists, cardiologists, psychiatrists, and now more recently a neurologist and ENT Doctor). The ENT noted I have a deviated septum which could or could explain the tension I have behind my eyes (constantly during the day I'm rolling my eyes into the back of my head as relief of the tension). When I saw the neurologist he ordered an MRI/CT scan w/o contrast and an ambulatory EEG for potential seizures. When the follow-up came, he said (paraphrasing) "there is nothing of note on the MRI scan" and that there was "slowing of certain brainwaves, but that doesn't really mean anything" (in regards to that, what do you mean it doesn't mean anything? It means something, it just must mean you don't know what it means and are giving me the vacillating answer is what I took of that). Anyhow, I asked for a copy of the test results from the radiologist and he obliged.. It should be noted that when I ask my neurologist questions, his answers are very terse "No, not really.", "Yeah, it's fine...". I literally have to become a real jerk to dig some answers out and still sometimes he doesn't give me a real answer (is this a legal thing? such as they don't want to put themselves on the line if they don't really have an answer one way or the other). Anyhow..

When I looked at the prognosis, the Radiologist had this sentence on the top of the paragraph "Sublenticular cyst versus asymmetric peri-vascular space widening on the right." What does this mean? So I have a cyst on or inside of my cranium that's causing some type of widening space? Also, no one actually showed me pictures of my scans at the neurologist and discussed various phases with me, it's really ticking me off. My life has been in dire straits mentally and it keeps getting worse and this guy can't even afford me the time (can't take no more than 5-10 minutes at best) to discuss different aspects of the scans. I had to call the next day and ask for images of the scan in CD format, and upon further review, I'd like some questions answered such as what this little black ball is that shows up on the back of my head at various phases..

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Can anyone explain to me what that black spot on the back of my head could be or is?

Could be nothing, could be normal, but it's a sad thing when a guy comes to a doctor and is letting him know how intense his problems are and he's giving me answers but no explanations just yes'ing and no'ing me.

Any elucidation to what these might mean will help. I'm currently awaiting a spinal tap on Monday, July 26 and am doing my own work of seeing if this may be a result of a disparity in my neurotransmitters. For a good year I was on and off a panoply of different anti-depressants, SSRIs, even aderrall and none of that worked. It should be noted that I did take depression medication off an on up until 2008, then went back to a psychiatrist in 2009 where he used me like some bad chemistry experiment and upon every visit imploring me that my symptoms were strictly the result of depression and anxiety (well if so, a. your medication is doing nothing to help me, b. you have no way of proving it, c. many tests have shown that these medications may be damaging receptor sites, etc.) I digress..

I apologize for the length. I'd be willing to reimburse for any further professional consultation. I really need some help, I'm walking through life right now in a half conscious state it feels like so I am willing to do almost anything at this point. Thank you for your time.
 Dr.M.Aroon kamath - Sun Jul 25, 2010 2:25 pm

User avatar Hi,
It is very difficult to put forth a confident, single diagnosis from the attached images alone. However, some of the differential diagnoses for this lesion seen in the posterior cranial fossa would include,
- a giant arachnoid granulation at the confluence of sinuses,
- a dermoid cyst,
- an epidermoid cyst,
- a cavernous hemangioma,
- dural sinus thrombosis,and
- a meningioma.

Among these, i have tried to provide you with some information on one of the aforesaid conditions, which can resemble all of the other conditions mentioned above and that, is a giant arachnoid arachnoid granulation.

Arachnoid granulations (pacchionian bodies) are normal structures that are multiple and seen mostly clustering in relation to the superior sagittal sinus. They were also described in relation to the lateral sinuses way back in 1920. They are bulbous structures consisting of fibroelastic tissue that are continuous with the subarachnoid space.The SF circulates through these granulations and then enters the venous circulation via the dural sinuses. Arachnoid granulations are known to increase in size and number with age.

Sometimes, one of them may enlarge markedly and present with the appearance seen in the supplied images. For CT images of cases of giant arachnoid granulations, kindly visit the following two links.
http://synapse.koreamed.org/Synapse/Dat ... -43-48.pdf

http://sumerdoc.blogspot.com/2009_08_01_archive.html

Usually they are harmless anatomical variations.But they have been reported to present with severe headaches,raised intracranial pressure and also with features of 'pseudotumor cerebri syndrome'.
Large, unilateral granulation in a dominant lateral sinus could cause partial obstruction of venous flow resulting in in intracranial hypertension.

MRI and CT with contrast can differentiate this condition fromdural sinus thrombosis and meningiomas but, it is difficult to differentiate from dermoids,epidermoids and hemangiomas because these also exhibit isointensity with the cerebrospinal fluid (CSF) on T1 & T2 weighted images on MRI scans.

The least i could do to help you is to provide you with some information. I hope this information may be beneficial to you.
Best wishes!
 Trent85 - Tue Jul 27, 2010 11:14 am

Thank you for this information, Dr. Kamath. I'm writing from my desk at home right now and I just received yesterday morning a spinal tap procedure. Of all the things pertinent to the procedure, I had to ask to have them test for raised intracranial pressure using the device that monitors the amount of CSF that comes out. These levels were considered normal and I must wait until next week to find out the findings of this test.

I guess my question to you would be can the presence of a cyst (dermoid, epidermoid, or otherwise) precipitate symptoms such as I've dealt with: the confusion and disorientation, the numbness and tingling, the weakness/fatigue/tiredness/malaise/etc., among other minor problems? There are a lot of what ifs right now, and if anything, we are getting closer to potentially finding something that may be at the heart of this all.

Once again, your opinion is greatly appreciated and will post further findings here if it is alright with the moderators here. It's amazing how much posing questions to doctors can make a difference instead of sitting back and hoping things get done.
 Dr.M.Aroon kamath - Sat Aug 07, 2010 2:24 pm

User avatar Hi Trent85,
It is difficult to explain all your symptoms by the presence of that lesion in the posterior cranial fossa. It is quite possible that that was an incidental finding.It is better to wait for the results of all the tests rather than to speculate.
Thank you for the update. Good luck!

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