Arachnoid cyst - surgery required ?

[Lozzycooper]

4.5 yrs ago, I started to have pins & needles on fingers, then feet. Then first 'attack' of strange symptoms-limbs shaking/no co-ordination/energy/loss of memory/foot drag on LHS. Admit to hospital, Neurologist sure it was MS. LP test - clear, MRI scan showed a small insignificant cyst. Improved after 8 weeks. Painful pins and needles on RHS face, numbness & pain down LHS of body, lack of power and easily tired have remained in the last 4 years. Last 3 yrs  taken Amitriptyline to aid sleep; day time made more manageable, as rested. Symptoms return severely if not taken. Recently my doc sent me for another MRI scan, as symptoms worsening & increases of dosage no longer having positive effect. Result of my recent MRI scan is:- There is an enlargement of the supra-verm,ian and probably also quadrigeminal ciste4ns, possible due to a large arachnoid cyst, with flattening of the inferior lying cerebellar vermis and some effacement of its sulci. This sulcal effacement would suggest that the cyst is causing mass effect rather than just a secondary expansion of the CSF space.  The intracranial grey and white matter return normal signal intensity.  The ventricular system, basal cistrns and sulci are otherwise normal in size and configuration. The craniocervical junction and midline structures appear satisfactory. Normal signal flow void was returned from the major intracranial vessels.opinio:- Enlargement of the supra-vermian and quadrigeminal cisterns, possibly due to a large arachnoid cyst resulting in flattening of the cerebellar vermis and some sulcal effacement.  No other abnormality, in particular no evidence of demyelination. This incidental finding has resulted in my neurologist requesting me to see a neurological surgeon to see if surgery is required. Do you think these findings relate to my symptoms, and if so, what do you think the chances are of surgery happening.  This cyst, I am told it is the original one found, but has grown in size, causing pressure.  Thanks

[Dr_Nassim]

I am WITH a treatment of your cyst.
this could be done by a valve

[Lozzycooper826]

I do not have access to my MRI scan - to send to you sorry - it is on my hospitals records. I don't know how I would get access either. I do know when asked, my Neurologist at my last appointment could not give me the exact size of the cyst - although he did say it was large and gave me an idea of its size using his finger and hands, which I measure to be 4inches/10cm or 1000mm.  When I saw the large white mass shown on the image of the MRI scan, on his PC, I could see it was, as he said large, especially in comparrison to my brain size. He did say this cyst was being flattened with pressure.  He also said it was at the back of my head, just above  my neck.
The only other information I have, is a copy of the MRI scan report, which I have detailed in my first post.  Sorry I could not be more helpful.

[Lozzycooper826]

test comment

[Dr_Nassim]

you told 100 mm you mean 10 cm ?  but it is quiet big, we cannot say that this is minimum at all!
can you send me your cyst MRI please? download it in your profile, because this size is surely creating a symptom !

[Lozzycooper]

Hello again and thank you again for your reply.
Thank you for the links, which I read and found very interesting, although noticed RLS article seemed to metion symptoms in legs and arms (in plural not single) sense) I presume you can get these symptoms in only one limb.
I have had previous blood tests, whereby Iron count was good and B12 defienciency was rulled out.
My left leg 'jerks' like a kick at night, waking me up.  I take 50mg of Amytriptilin, which I understand is a small dosage:- for depression dosages are I think are 25-150mg.
With a good night sleep, my balance also imroves and strength in left leg, enabling me to drive, withoiut my leg skaking when controling the clutch of the car. With or without medication - all my toes on my left food and always numb along with my left hand where the 3 outside fingers are always numb - worse fingers are on the outside of hand.
I am sorry - I don't understand this part of your post:-
'with the panic attacks you have much more symptoms responding on a triple dose of Amytriptilin' - can you explain please?  Thank you
My cyst I am told is a minimum is approx  4 inches wide (100mm).  I now have an appointment date in June to see a Neurosurgeon.  I hope you are right, that there is no connection and it will go away quickly. On a lighter note;-I am taking part in the Moon Walk (a well known and famous 13.5 mile chairty event in Britain)in June with my daughter to raise well deserved charity funds - training is rather slow - but I am making progress !  This will be a real challenge for me as it starts at 12 midnight my most tired time - but I am determined to finish it with my daughter.

Thank you again

[Dr_Nassim]

hello again
I was reading your last letter where you only mentioned the night spasm of your leg (as you are describing me RLS- Restless Leg Syndrome), with the panic attacks you have much more symptoms responding on a triple dose of Amytriptilin.

( http://en.wikipedia.org/wiki/Restless_legs_syndrome )

About surgeries of an arachnoid cyst, it is simple your neurosurgeon will puncture the cyst and place a tube inside connected to a small device called valve (this valve is special and should be low pressure regulated) the liquid drained from the cyst will be directed to the abdomen through a small tube beneath the skin traveling downward in the faty layer of the subdermis.

but my personal opinion is that the cyst has nothing to your sytoms.. many normally functioning people are discovered to have "silent "- type brain cysts.

please take a look to the link above (its

http://www.medhelp.org/tags/show/11932/Restless-Legs-Syndrome?center_adam=true),

read about the causes, including the lack in Iron.

you are most welcome
Dr Nassim

[Lozzycooper]

Hi thank you for your reply, which I apprecaite, as you are, I am sure very busy.  I found your answer very interesting.
If I can answer, as best I can to your comments:-  I take these tablets at night as a musle relaxer, not for any other reason.  I realise they can be prescribed as anti depressents, but can also be prescribed to stop bed wetting in children, people with MS or a sore joint - neither of these, are the reasons I am taking these.  I am lucky, I have never had a panic attack in my life, remain positive, enjoy life  and make the best of the strength I have, in my left side. Whilst I am sleeping (without these tablets) my left leg goes into spasms, kick and shakes, which wake me up.  These tablets don't send me to sleep just send my musles to sleep, enabling me to rest properly.  I have, however, also been to a psychlogist (the head of the dept in my region) over a period of six months, through my request to teach me methods of how to recall pieces of information. To be honest, maybe my doctor backed these visits, to rule out any signs of depression.  My Neurologisty and doctors were sent a lengthly report, basically, saying I was not depressed in any way, shape or form.  However the puzzles and tests I carried out showed that my IQ did not match the score in some tests, scheduling/planning using infomation given), which ties up exactly as I had reported I had found difficulty with in last fews years, along with the physical side. She asked to see me again in a years time - as raised concerns as to why there was a missing link to recalling some infomation.  
I had no idea that people who suffered from Panic attacks, could get these syptoms. ie. loss of balance, co-ordination, strength down one side of body.  Sure pins and needles of face along with tension headaches, I could understand, but other symptoms, I have never heard of .  I think you sent me a link to look into this, but there was nothing on your reply.
Can I ask you please ? As a surgeon, have you ever operated on an Archnoid Cyst or have any experience of these cysts, in this area (on my report) on the brain ?  
Many thanks again

[Dr_Nassim]

I cant not judge if your arachnoid cyst is the cause but it is very possible that you are experiencing serious panick attacks necessiatting treatment as you have benefit from an antidepressant.
Panic attacks; please read the table of symptoms about and find if you may have some of it.. and please let me know
Dr Nassim