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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 18453
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 4th year medical student in the UK. I have had a

Customer Question

Hi, I am a 4th year medical student in the UK. I have had a report back from an MRI that I had: "On the T2 weighted images there is an area of increased signal anterior to the right temporal pole 3cm x 1cm representing an arachnoid cyst." I managed to get an MRI done due to a study I participated in, not from my general practitioner. I have had some symptoms that have increased significantly after a fall to my head 2 years ago ( site of trauma was my nose to the floor). These include decreased levels of concentration, inability to get words out and have a flowing conversation, lack of thoughts in my head, "foggy brain", reduced emotional responsiveness (more apathetic these days), fine resting tremor bilaterally in hands and sometimes feet, find it more difficult to read aloud and follow conversations. Friends refer to me as more "dopey" and "less with it". I feel the same way.
Past medical history - Nasal fracture - 2011, Mumps - 2011, Otitis media requiring grommets - child, Tinnitus - started as a child. Full blood count, urea and electrolytes and TSH,T4 all normal ( done 6 months ago)
DHx - have tried citalopram and sertraline to no effect.
FHx - hypothyroidism, diabetes - mum. Primary immunodeficiency, immunothrombocytopenia purpura, organising pneumonia - dad. hypothyroidism - sister.
SHx - stopped alcohol/smoking cigarettes in 2012 to try and help these symptoms (no effect). Diet - 2000 calories a day, healthy. no recreational drugs.
In essense, do you think the lesion could be causing these symptoms, if not what neurological/general workup do you think I should ask my doctor. I have read literature and I would perhaps suggest FSH/LH, testosterone, B12, serum copper. Is there anything else? Thankyou for your help. I really do need some! I have the MRI on my computer if your able to take a look at it.
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. D. Love replied 2 years ago.
Has there been any discussion of a trial of other antidepressants?
Customer: replied 2 years ago.
No i find they adversely effect my cognition and become more 'spaced out'. I feel nowadays that the triad of low mood anhedonia and anergia dont apply, which is why i dont consider depression as part of the differential diagnosis.
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.
An arachnoid cyst of this size usually does not cause symptoms. As an arachnoid cyst gets large, it can compress the surrounding brain, but that is unusual for an arachnoid cyst of this size and there is no comment on any effect on the surrounding tissue on the MRI.
As for an evaluation, another consideration when there are symptoms that develop after head trauma would be formalized neuropsychiatric testing. These are a series of tests that can more formally assess brain function. For someone with persistent symptoms after head trauma, these tests are increasingly being used to characterize the effect of the trauma on the brain.
You are correct that a certain amount of metabolic evaluation would still be appropriate. I would assume that a general chemistry profile has already been done, including electrolytes,and liver and kidney function tests. A magnesium level should also be checked and frequently is not included in a general chemistry profile. Other endocrine evaluation beyond the testosterone and FSH/LH should include thyroid function and cortisol. Folate levels are also routinely checked with the vitamin B12 level.
I ask about the antidepressants because it is unusual to only try two antidepressants, and that the two are both SSRIs. I would note that antidepressants are used for more conditions than just depression, and your doctors may have been trying to use them to help with relief of other symptoms. But regardless of the reason for use, no antidepressant class works 100% of the time, so it is reasonable to consider a second antidepressant when the first does not work, but the selection of a second would usually be in a different chemical class.
If I can provide any further information, please let me know.