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subarachnoid cyst near L cerebellum
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subarachnoid cyst near L cerebellum

i am a healthy 35 year old woman who has recently developed severe migraines over the last several months.  i had a traumatic head injury in 1979 in which a metal plate was inserted L forehead without significant sequelae.  last week the headache whoever was so severe, i went to the er in which a ct scan was conducted.  the ct showed L subarachnoid cyst near cerebullum & encephalomalcia near area of trauma from accident in 1979 & deemed as normal ct.  my questions is, can the advent of these migraines have something to do with the cyst increasing in size hence increased intracranial pressure or are the migraines an isolated physiologic event.  i am to follow up with a neurologist but an experiencing angst & discomfort nonetheless.  help!
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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 your doctor.

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

I am going to assume that by subarachnoid cyst you mean 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. Arachnoid cysts are sacs filled with cerebropsinal fluid (CSF) which is the fluid that normally bathes the brain and spine. This fluid is normally located in the part of the brain called the subarachnoid space. 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.

Most commonly, these are primary arachnoid cysts, cysts that are present from birth and result from a minor developmental problem that occurred while the brain was developing. Secondary arachnoid cysts are those that develop secondary to trauma, infection, or after brain sugery, after epidural anesthesia, trauma, overdrainage of CSF due to specific draining systems placed for various reasons, or spinal injury or surgery. It is not always possible to tell if the cyst you have is primary or secondary.

The symptoms of arachnoid cysts vary depending on their size and location. Most are present since birth. Most people don't get any symptoms or problems from these cysts. In most people, they are discovered incidentally, or show up on imaging for a neurologic symptom, but are unrelated to the symptom. 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.  If the cyst is small it would be highly unlikely to be causing symptoms but this would really depend on its exact location and whether or not it is present on nerves or the brain or other structures.

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 arachnoid cysts identified incidentally probably should be left alone. More often than not, they are not the cause of any symptoms. If an arachnoid cyst is deemed to be undoubtedly causing symptoms or is pressing on surrounding structures (which would most often be evident on your MRI), surgical opening (fenestration) of the cyst and other surgical interventions could be done to correct it, but this is rarely necessary because the vast majority of arachnoid cysts are benign, do not grow, and do not cause symptoms. Sometimes, re-imaging to take another look at it after a few months or years may be indicated.

It is difficult to know without viewing your imaging if your arachnoid cyst is related to your migraine. Unless if there is an obstruction of flow of the fluid in the brain (CSF) or pressure on the brain tissue, it is unlikely to be causing symptoms. Migraines are much more common than headaches due to simple arachnoid cysts. It is a good idea for you to ask your physicians about more information about the cyst, what the implications of having it is, so you can have a good understanding of it; continued followup with your neurologist is recommended. The neurologist can also investigate other potential causes of the headache and if the diagnosis of migraine is confirmed (based on the history and examination), appropriate therapy can be started as the majority of patients with migraine respond well to the appropriate anti-migraine therapy.

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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