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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I recently had an MRI done to look pituitary tumor. It was

Customer Question

I recently had an MRI done to look for a pituitary tumor. It was discovered that my pituitary gland and stalk are enlarged. Also, there was a small enhancement on the right side on my pons. Weeks prior, I started experiencing involuntary head movements.
It started out as a few times a day. It seemed to have gotten worse, peaking at maybe 100 times per day. Now, it has settled back down to a few times a day. It is a subtle movement the tends to turn to the left. I believe I had a bad lupus flare 3 months ago.
Since, my health has declined. Could these movements be caused by the pons?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Did you have gadolinium enhancement of this enlargement in the PONS. A T1 FLAIR image? What you are describing in movements could be related to pons/tegmentum involvement as there are crossing motor fibers, the movement would be from involvement of CN 11 (spinal accessory) involving contraction of sternocleidomastoid muscle. One term is cervical dystonic movements. There is no way I can dx such a condition online, I am only giving you a possibility. Dr Frank

Customer: replied 1 year ago.
dye was used in the images in which the enhancement was detected. Is there any possible explanation as to why the movements seem to come and go? In your opinion, is this something that should be diagnosed? Or is it more of an annoyance that I will have to live with? Thank you.
Expert:  Dr. Frank replied 1 year ago.

Hi. If you have lupus, and if there is enhancement in the pons, then I would assume that you are receiving treatment for suspected lupus cerebritis (?) Your response to medical management (steroids, immunomodulators) would tend to influence this cervical dystonia. There are specific treatments for cervical dystonia in conditions where the cause is uncertain, and you are treating symptoms only. One example is spasmodic torticollis, where sternocleidomastoid, and other muscles of the cervical spine are tight and cause involuntary rotation of the head. Using neuromuscular blocking agents injected into those muscles, (Botox, Myobloc, etc.) is effective for lessening these episodes. I would suggest you discuss this with your physician as an option. I hope that answers your question, please get back to me if there is more information I can add. Dr Frank

Expert:  Dr. Frank replied 1 year ago.

Hello. I hope I was able to answer your question, please get back to me if you need further information, or rate my service as that is how I get compensation for my work thanks Dr Frank

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