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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34739
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Phophalia - i have an arachnoid cyst and a pineal cyst which

Customer Question

hello Dr Phophalia - i have an arachnoid cyst and a pineal cyst which are now squashing each other and displacing the local brain anatomy. my symptoms are vertigo, balance issues, headaches, nausea and vomiting, very poor memory (especially temporal) right side weakness, weird twitches (intermittent ) and possibly absences. i also have a condition called silent sinus syndrome which causes strange visual problems. My ENT specialist believes that my balance and nausea problems are caused by the arachnoid cyst, my neurologist believes that those broblems are caused by a combination of BPPV and mal(something) ie - inability to compensate for movement (especially after a sea journey) but i have not travelled more than 3 miles in the last 15 years and then, only by car or bus. i have had head injuries in the past but , after initial recouperation, have been ok. my symptoms started about 4 years ago, and have steadily worsened. the NHS neurosurgeons do not like to touch any non-malignant growths in the brain, but i am now effectively housebound and unable to do many basic things for myself. would surgery to drain/remove cysts be more beneficial or would the risks outweigh any benefit?
JA: Is the headache episodic or daily? And what about nausea?
Customer: i have a low grade headach constantly that turbos about twice or more a week for several hrs. the nausea happens on head movement and vomiting signals onset of mega headache
JA: Anything else in your medical history you think the doctor should know?
Customer: i was a super fit athlete and iceskater with above average balance. i have suffered bereavement but that has been throughout my life and i am now past the (lost ) 18 month stage since the last one. i have low blood pressure and slow heartbeat but no diabetes, heart problems and my cholesterol is low
Submitted: 10 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 10 months ago.

I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Let me at the outset tell you that surgical risk outweighs the benefit. Arachnoid and pineal cysts are rare to cause all of your symptoms. I would like to now your age and gender, and than we can discuss all of your symptoms collectively. Here I am just handling the balance coordination initially and than we would discuss rest of them too.

Following are the possible causes of balance and in coordination problem;

1) Sitting balance and arising from chair problem; proximal muscle weakness, arthritis, or neurologic disease are the causes. Treatment is muscle-strengthening exercises, and treatment of specific conditions, such as arthritis.

2) Neck turning and extension; Neck arthritis (cervical arthritis, cervical spondylosis), or vertebral-basilar insufficiency can cause this. Treatment options include avoidance of quick head-turning and physical therapy.

3) Standing balance; causes are orthostatic hypotension, cerebellar disease, sensory deficits, muscle weakness, or pain. Treatments are muscle strengthening, using an assistive device, improved foot care, medication adjustment, and treatment of specific diseases.

4) Unstable turning around; causes to consider are cerebellar disease, hemiparesis (stroke), visual field cut, or reduced proprioception (sensation). Treatment possibilities are assistive devices, proper shoes and gait training.

5) Unsafe sitting down; may have proximal muscle weakness or poor vision. Treatment options include muscle strengthening, raising the height of the seat, and visual assessment.

Thus these issues are usually result of composite issues:

You may need following investigations (if not done;

a) Muscle charting for the muscle strength

b) MRI with contrast and magnetic resonance angiography of the brain and spine

c) Electromyography

d) Blood work like CK which is a muscle enzyme.

e) Parathyroid hormone assay

Mainstay of the treatment is usually physiotherapy / physical therapy.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 10 months ago.

I would also recommend colored doppler study of the carotid arteries (neck arteries which take blood to the brain) and MRI with gadolinium contrast; if not done yet. These may show narrowing of the arteries and resultant decrease in blood flow, which in turn may be responsible for your all of the symptoms. Acoustic neuroma too is another diagnostic possibility for your manifestations, which also would be ruled out by it.

Following are the investigations which may help in clinching the diagnosis;

1) audiometry,
2) vestibular tests.

The most commonly performed vestibular tests are as follows:

Electronystagmography (ENG)The rotating-chair test, also referred to as sinusoidal harmonic acceleration (SHA), Computerized dynamic posturography (CDP).
3) blood tests for autoimmune disorders,
4) computed tomography (CT), and magnetic resonance imaging (MRI).

5) The saccadic test
6) The gaze test
7) Pursuit eye movements test
8) Optokinetic Nystagmus test
9) Head shake nystagmus test.
10) Positional nystagmus testing
11) Bithermal calorie test.
12) Rotating chair test.

13) An alternative to the rotating-chair test is the active head-rotation test,

14) Computerized dynamic posturography

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 10 months ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited and paid for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 10 months ago.

My goal is to provide you with the best service possible. If you feel I have done so, then an "Excellent Service" rating is greatly appreciated! If not, please click "Reply" to let me know how I can better assist you with any additional information or clarification.

Thank you very much for the opportunity to be of help!