Brief Answer:
Probable PINEAL CYST

Detailed Answer:
Good evening. Thank you very much for your question. Your MRI reading is identifying a common and benign entity known as a PINEAL CYST. These do occur and are visualized on radiographs when MRI's of the brain are obtained. But they are rarely of clinical importance unless they can be shown to be compressing other structures in the area.

I suspect also that the term HYDRONEPHROSIS should be HYDROCEPHALUS.....The first term relates to the KIDNEY ballooning up with fluid while the 2nd term refers to ballooning of the ventricles in the brain. Since we're talking about a brain MRI I see no role with the term HYDRONEPHROSIS to be in the report...it's a typo.

Everything else looks good.

If you were my patient with this type of MRI then, depending upon your symptoms and how they may fit with the picture I would either tell you that you are the lucky and proud owner of a BENIGN PINEAL CYST which is rather small as these things go at 1.5 cm. in diameter.....or if I were more interested in delineating the cystic portion of the lesion I would get a repeat study on you using GADOLINIUM CONTRAST which is XXXXXXX injected into the vein.

I would first ask you to get a kidney screen to make sure you have good ones since gadolinium XXXXXXX can be harsh to a small percentage of people. I would ask you to get a Creatinine and EGFR (Estimated Glomerular Filtration Rate) calculated by the lab and I would give you the XXXXXXX if your EGFR were about 59 or 60.

I'm sure after the gadolinium contrasted study everything would probably read out the same as it is now...but the idea of the 2nd study would be to really be certain that the pineal cyst is full of CSF fluid and not anything else that needs further analysis or removal.

That is all the report reads...I would not get otherwise excited about things....and by the way, if the reason you got the scan in the first place was for headaches....then, unfortunately, you've not necessarily found the cause for your headaches either so I wouldn't be rushing off to a neurosurgeon with this scan asking if they would please schedule for immediate brain surgery....no reputable brain surgeon I know of would even think about trying to remove something like this so don't let anybody push panic buttons either on the basis of this scan.

Cheers!

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 11 minutes of time to read, research, and respond.

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Brief Answer:
CT scan results of little value to the clinical presentation

Detailed Answer:
Good evening. Thanks for your clarifications and I believe you've actually been having some additional days sick than just 35 days (closer to 84).

The note from Dr. XXXXXXX is actually dated Nov. 7 and states that you had been sick to that point by 2 weeks. This would suggest that you had been ill since around the 4th week of October which is closer to 12 weeks (3 months) and this is so much more than 35 days that you're mentioning at the top of these complaints. Unless you actually got better and cured and relapsed in the past 30 days???

As far as the imaging study of the head is concerned and its meaning with respect to your symptoms- I don't find the results helpful in order to explain what you're suffering from in terms of this chronic viral sounding presentation. CT scan seems to show the presence of a PINEAL CYST of a benign nature and as I said earlier, in the vast majority of cases these findings are incidental and don't move us to do anything else. I'd be curious to know if the MRI confirmed the presence of the pineal cyst or did it "see" something else in terms of the low attenuated density of 1.5 cm?

Obviously, it's not a bacterial infection that you've got since you've been on 2 rounds of antibiotics. Have they been looking at other systemic problems such as autoimmune antibody complexes. One thing that could be looked for in this type of vague, unclear, chronic problem which isn't responding to anything conventional or obvious would be some type of VASCULITIC problem. For that they may need to do a number of blood tests, do a bit more in terms of a pulmonary workup with perhaps a spiral CT of the chest or MR to see if something shows up in the lungs such as granulomatous lesions that could be very small and otherwise undetectable by standard X-ray. Then, there are other things such as autoimmune deficiencies so there may need to be repeat bloodwork. Have you checked for HIV and other STD's which can sometimes masquerade as weird chronic or sub-chronic viral diseases, hepatitis?, etc.?

If I were your doctor then, I could see myself ordering a fairly complex autoimmune workup and getting things such as an ESR, CRP, all thyroid panel hormones, ANA panel, Lupus Anticoagulant, RF, spiral CT of the lungs, and I'd do a kidney search/spiral CT vs. MRI for what those abnormalities could be that Urgent Care found with an eye once again toward a VASCULITIC type of problem.

Vasculitis often presents in the lungs or kidneys as some of the most commonly affected organs if nothing in the brain is discovered. I'm assuming that since you've seen the ENT specialist that they've done a more robust set of films of the sinuses as well just to define and be sure you didn't have anything there that could be part of the picture of vasculitis or allergy with the presence of retention cysts or polyps that also produced this chronic viral looking picture?

I don't think I would be compelled at this point to do a spinal tap or lumbar puncture until we knew what the MRI of the brain showed.

In the mean time, I might also prescribe you HIGH DOSE VITAMIN C on the order of 2500-3000mg. daily in PURE POWDER extract crystalline form (not tablets or pills...those are pretty worthless overall due to all the junk they put in the pills). I'd also just for the heck of it check into your VITAMIN D, D2, AND D3 parameters and correct those since you are likely low (everybody is...). The numbers you're looking for are 60-80...not what most doctors will accept as just above the lowest limits of normal which are in the 20's or 30's. I would still supplement you at those low levels (even if they tell you it's normal).

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 96 minutes of time to read, research, and respond.

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