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Brain cyste, and now what?
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Brain cyste, and now what?

Due to severe headaches i had a MRI of my head taken in nov. 09. The preliminary diagnosis was clusterheadache and i started taking Verapamil. In feb.10 i was to go back to the neurologist for the result of the scan. A week before that i woke up one morning and the whole of my leftside was totally numb, not paralyzed but numb and tingling. Very bizar, like i was split in half. After a few days i was left with a numb left underarm and foot. My GP gave me a bloodthinner because he tought i might have a vessel problem in my head. He wanted me to see a neurologist, but since i had to go there in a few days anyway .... When i got there i mentioned him that i had developed something new and scary, he said 'i know'. He showed me that i had a brain cyste the size of a cherrypit wich was situated in the somatosensoric region of my right hemisphere He found it strange that it hadn't shown up in a scan i had three years ago because of aura symptoms without the migraine pains. He scheduled me for another MRI, this time with contrast to see what, if anything, was wrong with the vessels in that region. In the meantime he upped the dosage of the Verapamil for my headaches, witch kinda helps. The result of that MRI showed no size-increase of the cyst and the vessels were okay. He advized me to have therapy for my hand and that was it!!! I did some Google-ing on the subject and nine out of ten times it is advised to remove or drain the bugger. You can understand that i'm a bit confused right now. The symptoms are still there and they are a real bother. Driving a car ain't happening anymore, i don't feel the steeringwheel, i already had a little fenderbender because of that. Lots of other things that you normaly just 'do' without thinking, have become a real task.  I am thinking about getting a second opinion, but in the meantime maybe someone on this board can educate me a bit more on the matter. Thanks in advance.
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Several types of cysts occur in the brain. Not all cysts are dangerous, and not all cysts need to be removed.

One type of cyst is the arachnoid cyst. Our brain is covered by a layer of tissue called the meninges. This layer of tissue is made up of 3 layers, one of which is called the arachnoid. An arachnoid cyst is a developmental cyst that occurs in the arachnoid membrane. They can occur anywhere within the central nervous system (brain or spinal cord) but are most commonly found in the brain. Sometimes, more than one can be found in the same person.

The exact cause of arachnoid cysts is unclear, but the majority are thought to be developmental: occur as a human develops, present since birth. Secondary arachnoid cysts, cysts occurring from a particular reason, are much less common. They can occur after epidural anesthesia, overdrainage of CSF due to specific draining systems placed for various reasons, or spinal injury or surgery. Since your cyst was not seen on first MRI, it is likely that it is not a primary developmental cyst. Again, it is difficult  know which type of cyst you have. Other types are dermoid cysts, epidermoid cysts, and these can be distinguished between with the appropriate MRI sequences. Sometimes, a prior small stroke or head trauma can be mistaken for a cyst; thorough review of the MRI will distinguish this.

In most people, they are discovered incidentally, when MRI of the brain is being done for whatever reason. Care should be taken when attributing the patient's symptoms to the presence of the cyst. Symptoms that may be caused by arachnoid cysts (depending on their location and size) may include seizures, psychiatric problems,and headaches. Complications from cysts including bleeding (subdural bleeding), but this is not common. It is difficult to tie your headaches to the cyst given it's size and location that you describe above. The sensory symptoms you are having could be attributable to the cyst given its location.

Some cysts resolve spontaneously, but most arachnoid cysts remain the same size or increase in size only slightly in adulthood, and others fluctuate over time.

Asymptomatic cysts identified incidentally probably should be left alone. In cases with epilepsy where the cyst appears to be under pressure, surgery should be considered, although it may not result in seizure control. The decision to operate is usually taken by a neurologist and/or neurosurgeon. If a cyst is determined to be causing symptoms or pressure in the head, it may be removed, but consideration as to the risks of surgery vs. the risks of leaving the cyst should occur. If a cyst in the somatosensory cortex is operated on, the deficits resulting from the surgery itself may be worse than the symptoms resulting from the cyst.

Another type of cyst found in the brain is an ependymal cyst, which comes from a different type of tissue than arachnoid cysts but the same discussion holds true regarding the fact that they may be discovered incidentally and may not require intervention. However depending on their location they may cause a blockage of the flow of CSF (the fluid that surrounds the brain and spinal cord) leading to increased pressure in the brain which may require surgical intervention.

Sometimes, tumors and other lesions in the brain such as infections can appear as cysts as I mentioned, and the radiologic appearance of the cyst can give clues as to the cause.

Continued discussion of your concerns with your neurologist is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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