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Date of last update: 10/04/2017.

Forum Name: Neurology Topics

Question: Dr overlooking 15mm Pineal Cyst, lumbar puncture necessary?

 MusicIsMyLove - Fri Jan 09, 2009 1:27 pm

Hello, 26 year old female here just found out from MRI of a 15mm pineal cyst. Two nuerologists were unconcerned one telling me he's never had a paitent with a problems from cyst before. Last doc recommended a lumbar puncture because I am overweight he feels it could be due to fatty cells interupting my cerebrospinal fluid causing water on the brain. However I am not finding any information on this subject. I have been reading, however, that a lumbar punture may be dangerous to do with the intracrainel pressure I have. I'm very scared that the cyst is causing my problems and worried that the doctors are overlooking my diagnosis. Please help! I'm experincing extreme head pressure, dizziness, blurred vision, visual disturbances and delayed problem solving/thinking making it impossible for me to work.

Thanks for reading and look forward to your response!
 John Kenyon, CNA - Thu Feb 19, 2009 11:31 pm

User avatar Hi there --

Pineal cysts are fairly common and the majority are not symptomatic. Yours is, and that's where the problems arise. The symptoms, in a situation like yours. are telling you what you need to know: increased ICP can be not only painful but beyond a certain level can be dangerous.

You seem to have gotten a rather mixed bag of results, medically. Just because a given doctor has "never had a problem with a patient with a cyst before" doesn't mean you're not having a problem, and it certainly deserves attention. Also, the theory about body fat compressing the CFS and thus increasing ICP seems really odd. However, the lumbar puncture still seems like a sound idea, even if the reasoning is odd. I'm not sure why you feel this would be dangerous because of the already high ICP you're experiencing, but this is often done to reduce ICP at least temporarily. While there are sometimes direct surgical removals that can be done it is often a difficult place to reach, so either therapeutic LP or placement of a shunt if the problem cannot be otherwise resolved.

The only problem with lumbar puncture is the occasional rebound headache, but this is manageable and seems rather unlikely in the case of already elevated ICP, so it should at least provide some temporary (and perhaps permanent) relief.

I hope this is helpful to you. Please follow up with us as needed.
 MusicIsMyLove - Sat Feb 21, 2009 6:45 pm

Thank you for your response. I successfully went through the lumbar puncture, my pressure was at 29. The neurologist drained my CSP down to 22 and left it open to drain. I suffered through the spinal headache post lp. As soon as the spinal headache left, my original symptoms remained. I also had a rumbling sound in my head for a week.

The doc noticed my optical nerves were swollen, a cause for my vision problems. With this finding and the high CSF pressure he discovered, his diagnosis is Pseudotumor Cerebri. He prescribed my Diamox for the fluid and Midrin for headaches. I have been on the Diamox for about 3 weeks now. I'm slowly feeling less pressure and better vision, but I still suffer the headaches or migraines daily. The doc also said my optic nerve wasn't as swollen as it was when I came to his office. I've also successfully lost 8 lbs with diet which he also recommended for treatment. He wants to see me again in 3 months.He's still not concerned about the pineal cyst and wants me to get MRI's later down the road to watch.

I feel relieved to have a diagnosis, but still worried about the cyst. Also, I haven't found very much research on Pseudotumors.

Are you familiar with Pseudotumor Cerebri and do you have any recommendations or thoughts about this? How often should a get an MRI to watch this cyst?

I appreciate your feedback, it always helps to get a second opinion. Especially with the potental dangers of the ICP.

Thank you!
 John Kenyon, CNA - Tue Feb 24, 2009 12:06 pm

User avatar You're welcome. The lumbar puncture then went without incident and may have temoporarily helped a little. I have been passingly familiar with pseudotumor cerebri, but now have done more research on it, and yes, I'm pretty certain this would be a correct diagnosis. Everything fits the profile. Also, for some reason (and I was previously unaware of this) it seems to occur most often in overweight females, so the weight loss suggestion was not without basis. You're off to a good start with that, too. DIamox is the medical therapy of choice, and has a fairly good record for helping correct the symptoms. In those for whom it doesn't work, surgical placement of a shut to keep the ICP lowered is often performed. Also, regular optical evaluation is important because of the potential for vision loss due to swelling of the optic nerve (and optic nerve fenestration to relieve swelling is sometimes done to preserve vision in otherwise unresponsive cases). While pseudotumor cerebri is considered "benign", it can certainly cause some very serious symptoms, including, as you already know, severe headache, nausea and occasional vision compromise or loss. Starting with Diamox is a very good idea, and if it seems to be helping (along with weight loss), hopefully nothing more invasive will be required.

Please stay in touch regarding your progress. Best of luck to you with this.

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