Expert: Claes-Gustaf Nordquist, M.D. - 3/1/2008

Question
QUESTION: I am a 31 yr old female who has never had headaches and now for the past 4 weeks I have frequent pressure headaches that are not responding to Tylenol, Advil, or even Imitrex.  So now my M.D. sent me for a CT scan of my brain that showed a benign mass on my right side of the midline.  I was then sent for a MRI with and without contrast and was told that it was fluid.  Does the mean the mass is a cyst.  I am now being referred to a neurologist whom I hope can tell me a little more about what is going on and what these test results mean.  I also wonder what tests or treatments lie ahead, and if this mass or fluid is responsible for my headaches, anxiety and memory loss I have been having.  Thank you for any input you may have.

ANSWER: If this mass is big enough it may be responsible for your head aches. If it is filled with fluid it is per definition a cyst. If it is benign it is NOT cancerous. Usually such lesions are - if necessary and possible - treated with surgery though small lesions may be destroyed radiologically with the GammaKnife or the CyberKnife or proton beams. Your question does not contain emough information to evaluate if surgery is necessary or possible in your case or if indeed your head aches are caused by this mass though it seems probable. The neurologist can probably evaluate these things for you. Good luck!


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QUESTION: I saw the neurologist yesterday and he said that he thinks the headaches are migraines or tension headaches.  I then asked him about the CT results and MRI results and he then left the room to go read the reports that were faxed to him.  He came back and said that the was no mass that the MRI showed only some fluid and that he didn't feel that the fluid was insignificant according to the radiologist report and he was pretty sure that it is not contributing to my headaches, but to be 100% sure he wants me to bring the actual MRI films in.  I am certainly not a Doctor or a Neurologists but I am pretty sure these are not typical migraines, they do meet some of the criteria of tension headaches, he also prescribed MIDRIN, which made me feel really weird.  I thought migraines lasted for a day or so and then passed. My headaches have been everyday for 4 weeks and they feel more like pressure and squeezing of my temples.  Another thing is that the headaches started 4 weeks ago when I had a severe sinus infection, I am not sure if there is any relation to that either.  I have heard that an abscess can be related or caused by a severe sinus infection, I guess I am just trying to find any relation to when these headaches started, my MD prescribed Darvocet and those are the only thing that will give me a little relief for maybe an hour or two. Also if I haven't mentioned this before I have been have progressively worse memory loss also. Still searching for answers here any advice would be greatly appreciated. Thanks Again

Answer
Well I'm not a neurologist (I'm a medical oncologist & radiation therapist with experience in treating brain tumors) so I'm hardly in a position to contradict your neurologist. The only possible solution to this problem that I can suggest is a second opinion from another neurologist.