u/RusticHallscape

▲ 1 r/Radiology+1 crossposts

Symptomatic Choroidal Fissure Cyst with Hippocampal Formation Mass Effect: which specific sub-structures is it distorting?

Hi all! Right-sided arachnoid choroidal fissure cyst here (first diagnosed via MRI in 2015). The video/images included are all from the latest MRI in 2020.

TL;DR: my cyst has fluctuated in size/distribution, and MRI reports since 2018 mention mass effect to the hippocampal region. I'm hoping someone can help me identify in more detail which specific anatomical (sub)structures are affected because the latest report I have is vague in that aspect. About in 2018 I saw a nationally-recognized neurologist in my home country who explained that the cyst was likely causing (or exacerbating) some of my psychiatric symptoms due to the specific placement. Where I live (Australia) the imaging reports are a lot more vague so I can't tell if the mass effect they refer to now is the same or not as the one my neurology team identified back home in 2018. If there are changes in which sub-structures are affected it'd help justify the substantial expense of seeing a specialist neurologist here given that the cyst itself doesn't require actual intervention.

I have access to the entire set of images in case that helps with more detailed identification.

Detailed background/case presentation:

I've been monitoring my cyst since it was first diagnosed in 2015, which has fluctuated in size over time. For reference, all MRIs were done at the exact same imaging clinic where I live (Australia) except for the one in 2018 that was done in my home country (Argentina). In Australia my MRI reports have gone directly to my general practitioner (GP), unlike in Argentina where I discussed them at length with a neurology team.

At first in 2015 the largest measurement was 18mm and there was no reported lesion/mass effect. A follow-up MRI in 2016 showed no changes.

In early 2018 an MRI showed it had grown to 24mm and lesions/mass effect were first mentioned. The report I received in 2018 was more detailed because it was written by the neurologist I was seeing in my home country when I went to visit. I was given a lot more detail about the affected sub-structures, including the fornix which appears to be symptomatic due to issues I have with spatial navigation. They also suggested strong links with increased anxiety and increased impairments from my Autism and ADHD.

A follow-up MRI in Australia in late 2018 confirmed an increase in size from 2015. There was only a 1mm difference between the 2018 MRIs in Argentina (24mm) vs Australia (23mm) so that ruled out a technical discrepancy.

The last MRI from 2020 showed the cyst had reduced in size (down to 19mm) closer to its original size in 2015. But the report still mentions 'mass effect with distortion to the hippocampal formation'.

I was hoping someone could give me more insight on the specific sub-structures/regions that show mass effect.

Thank you in advance!!

u/RusticHallscape — 11 days ago

S4E4: Julie Scene Explained (my thoughts)

Two things: 1) I think Julie's strategy will work with some tweaks; 2) this makes me wonder if the notes in the bottle tree are other storywalkers' attempts at time travelling 'bookmarks'.

I think Julie's bookmark strategy didn't work because she is treating time travel as if she only has one body that she moves across time/chapters. If that were the case the note would change because she's carrying a single copy of it back and forth and editing it.

But the way time travel works in the town seems to be more like an apparition or projected body double. When Julie crosses the threshold she doesn't disappear and physically go somewhere else (like when people use the faraway trees, for example). Her primary body physically remains in place in the present in a seizure.

So she's not time travelling in a traditional sense where one body goes from point A to point B. She's 'projecting' an apparition of herself in another timeline: so her body stays in point A while she simultaneously sends her consciousness and a 'copy-paste' version of her body to point B.

When she's pulled from the threshold her apparition/projected version merges with her primary physical body (the one that was in a seizure). But it appears that the merging only happens internally, like her projected mind/consciousness returns to her seizing body.

We know that she can take things with her (ie clothes, pen, paper) when she projects herself into point B. But in reality what she's doing is bringing a copy of an item with her. So this doesn't seem to alter the original copy she has with her while she's seizing (ie the symbol she draws in point B doesn't magically appear in the paper in point A). For example, if she drew on her jacket with a sharpie in point B the writing wouldn't magically appear on the jacket while she's seizing in point A.

The fact that storywalking effectively involves creating copies of objects to send into the past it does make me wonder if instances like the bracelets (and maybe even Boyd's wedding rings) are related.

I wonder if Julie could create talisman copies this way? If she crossed the threshold with one in her pocket (like the piece of paper) and then buried it deep in a recognizable part of the forest. If she came back to the present and dug that spot there could now be two talismans: the one she had in her pocket while seizing and the copy of it that her storywalking self buried.

I still think the bookmarks might work the way she intended. She left the symbol X in point B. Maybe if she goes through the threshold again with a piece of paper that has the same symbol she'll project there. Once she attaches a symbol to a point in time (by leaving it there as a bookmark) she just needs to use the same symbol to 'dial in' next time she wants to go there. Like a phone number: once it's assigned you just have to dial it to connect through to your intended target.

As others said there is also the option that the copy of her bookmark did appear in the present but where she dropped it (ie in the main town road rather than her jacket pocket).

This makes me wonder if the numbers in the bottle tree are a collection of bookmarks left by others. For example, if they tried to use numbers for chapters instead of symbols like Julie did.

The tricky thing is that to test it she'll effectively have to go back to a very scary point with the MIY charging at her. Or she'll have to do another blind threshold cross with a blank piece of paper, hoping she'll land on a safer chapter to leave a bookmark and experiment further.

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u/RusticHallscape — 12 days ago