How to manage an 18 x12 x10 mm cerebellopontine angle cyst?

Question

Hello doctor,

MRI report shows: Left cerebellopontine angle arachnoid cyst measuring 18 x 12 x 10 mm, displacing 9th and 10th cranial nerves ventrally. Misc- prominent bilateral level 3 lymph node, as well as left level 2A lymph node measuring 29 x 11 mm. I went to an ENT (Otolaryngologist) because I was dealing with terrible pressure in my head and also pulsatile tinnitus. I constantly hear my heart beating or blood pumping in my left ear.

I have had grand mal seizures and a febrile seizure when I was a toddler. In 2018, they did not see anything in my CT scan. ENT referred me to a neurologist for the pressure in my head, which was migraines, and also to a neuro-otologist for the cyst, who then referred me to a neurosurgeon, whom I have not gone to due to the Covid-19 outbreak. The only procedure I ever had was an epidural injection in my lumbar for a bulging disc, and after the procedure, I dealt with massive headaches. The doctor told me they would subsidize.

I am 21 years old. I am seeking opinions on this matter and would like to know how it should be addressed. Forgot to add that I have been dealing with neck pain also now.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I would like to know more about your headache, heaviness in the head, like the location of pain, frequency, severity, a particular time of the day when it occurs, associated vomiting, nausea, or blurring of vision. How long does it last? Does it require medicines to be taken always? I would also like to know if tinnitus is in the left ear only? Any medicines for seizures?

Also, it would be nice if you could send images of an MRI (magnetic resonance imaging) to have a better idea about the arachnoid cyst. Please elaborate on the problems and answer all these questions, and send MRI images so that I can suggest better.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

So, considering the headache you have, it does not look like migraine, nor is it due to the arachnoid cyst. A forehead headache may also be due to sinusitis. In case if you have frequent episodes of common cold, nasal blockage, etc. If you have that, you might need to take steam inhalation and consult an ENT surgeon. And for headache, I would suggest continuing to take on an SOS (if required) basis when the headache starts or you feel like having it so that it does not increase in intensity.

Tinnitus might be associated with an arachnoid cyst or vascular compression on 7 to 8 complex, despite the MRI showing that (according to the report) there is not much pressure. As such medicines seldom help in such cases, but if it is due to ear pathology, which has already been ruled out, there might be some help with medicines. If the frequency of headaches is not much, then prophylactic drugs are not required. I think you should see a neurosurgeon once the situation improves. To be evaluated by him for the cause of tinnitus. If we had MRI images, it would have been of great help.

I hope this helps you.

Thank you.