Brain Cyst? WTH?

May 28, 2010 9:55 AM

How serious is an arachnoid cyst in my brain?

YANAD, YANMD, of course.

So this morning I got quite a blow to the side of my head, and ended up in the emergency room being checked for a concussion. I had a CT, and while it didn't show any swelling or hemorrhage where I was hit, it did show an arachnoid cyst pressing against my cerebellum, just above where the brain stem enters the brain. The ER doc said it was right up against my balance center, which might be causing headaches. The report specifically said it was an arachnoid, not an epidermoid, cyst. I assume this is significant?

The ER doc said I should follow up with my GP and I'd probably need an MRI and they would follow it closely for 6 months to a year to make sure it wasn't growing.

I had a CT about ten years ago for a persistent headache (diagnosed with migraines), and I don't remember the doctor mentioning a cyst.
In addition I was in a car accident in 2005 that resulted in two bulging discs in my neck. I have had more headaches lately but both I and my neurologist thought the neck pain was probably causing it.

So, getting to my question...what the hell? a CYST in my BRAIN? Granted, I realize I would probably never have known about it if I hadn't gotten walloped upside the head, but what should I expect? I have a neurologist, as I mentioned above--should I go see him about this instead of my GP? Anyone out there with a similar situation who can tell me what to expect? Could the trauma of the accident in 2005 have anything to do with the appearance of the cyst?

posted by Mimzy to Health & Fitness (15 answers total)

AskMe cannot really help you here. You need abundant hands-on medical attention.

It's a cyst. IN YOUR BRAIN. It may not not be dangerous. But it's IN YOUR BRAIN. So, yeah, it's pretty significant.
posted by Cool Papa Bell at 9:59 AM on May 28, 2010 [1 favorite]

Best answer: I wouldn't bother with a GP when it comes to cysts in your brain. Call your neurologist. This is kind of his "thing".
posted by amethysts at 10:02 AM on May 28, 2010 [3 favorites]

Best answer: My father has one. The neurologist thinks that it's been there for years. Once a year they check it out to make sure it hasn't grown. The plan is, if it's not growing, leave it alone. If it does start to grow and starts impinging on vital brain bits, then they will remove it. His is in a different spot than yours is, though.
posted by crankylex at 10:09 AM on May 28, 2010

neurologist first, not your gp.
posted by JohnnyGunn at 10:30 AM on May 28, 2010 [1 favorite]

Call your neuro ASAP and tell him you need to talk about these CT results; get the results sent to his office.

Anecdotally, I know someone with a brain cyst and they're fine, although it gives them migraine-like headaches and they get to have an MRI once in a while. However, none of us can tell you what having a cyst means for your specific case.
posted by fairytale of los angeles at 10:31 AM on May 28, 2010

The only thing your GP will be useful here is to get you any needed referrals to your neuro. And further along the line, they're good for prescription refills that originate with your neuro. But that's it, in my experience with all things brain related.

Bring all your questions to your neuro; we can't answer them here. Heck, your neuro might not be able to answer some things definitely, but at the very least they know brains and they know a heck of a lot more on how to keep them working :)
posted by cgg at 11:01 AM on May 28, 2010

BTW football coach Urban Meyer has an arachnoid cyst. You might learn something by Googling him.
posted by cda at 11:50 AM on May 28, 2010

Arachnoid cysts are usually present from birth (although they rarely result from injury, but not acutely, so that probably doesn't apply to you). More information can be found at this page from the National Institutes of Health. They are often an incidental finding and may be so in your case, but since you have a history of headaches go to your neurologist, with a copy of your scan if possible. Even if you end up needing surgery it is a pretty straightforward procedure (as brain surgery goes), so don't get all panicky. But do follow up with your neurologist.
posted by TedW at 12:06 PM on May 28, 2010

Best answer: My husband has one (we have named the cyst Harvey). It was found because he had persistent ringing in his ears, and in the course of getting that checked out to see if there was a cause, Mr. bibbit had an MRI. And so we met Harvey. Same thing for him as what others have mentioned: MRI once a year to check on the growth, occasional headaches (though whether that's because of Harvey or just normal stress, no one can tell), probably there since birth. The docs don't think it's the cause of the ringing, FYI.
posted by bibbit at 1:26 PM on May 28, 2010 [1 favorite]

Response by poster: To followup, I called my neurologist's office and I'll be seeing him in a couple of weeks. That made me sit up, because they apparently fit me in at the earliest possible moment -- i usually have to wait months for an appointment.

Thanks for the advice, everyone.
posted by Mimzy at 1:45 PM on May 28, 2010

Just chiming in to say that my dad has something quite similar (in his spinal column, not his brain, but he's still seeing a neurosurgeon). He gets an MRI every other year. If nothing changes next year, they'll probably drop back to every three.

So yes, get this checked out like you're planning to, but it's entirely possible that this has been there you're whole life and is growing slowly enough that you'll have the pleasure of dying from something completely unrelated a number of decades from now.
posted by valkyryn at 3:35 PM on May 28, 2010

My oldest son had an arachnoid cyst that we found at the age of 5 when going through the course of tests for his always low growth rate.

At that age, we went to see a neurologist in Memphis who was a specialist in the field of arachnoid cysts in children. It was rather amusing to flip through a medical book at another children's hospital to find out that he literally wrote the chapter on arachnoid cysts in children.

They did a couple more CT scans on my son, and the doctor informed us that the cyst was rather large, and was already putting pressure on the optic nerve, as well as the pituitary gland. For the optic nerve, it was a legitimate and immediate concern, as it could begin harming his vision at any point (or of course never be an issue, but the odds were likely). For the pituitary gland, it was a possible cause of his lack of growth, but could not be proven conclusively - nor did it matter, as we later went onto growth hormone treatment and has consistently moved up the chart over the last five years.

The neurologist also told us about his extensive studies on the possible learning disabilities appearing in children with arachnoid cysts, and that was a large concern of his with regard to the size and location of the cyst. His recommendation was surgery to remove the cyst, and after consideration we agreed.

He went through the surgery very well, but I've never been so scared in my life. He was down for a week, and then up and around. Unfortunately about three weeks later there was a complication, with spinal fluid leaking internally in the area of the surgery. That resulted in an emergency trip back to Memphis, where the procedure was repaired and all was well.

Five years later he is a healthy and normal kid, the surgery scar hidden under his hair behind his ear, and we are lucky in so many ways.

And we got to take home a DVD of his surgery, which was pretty cool to see.
posted by shinynewnick at 4:42 PM on May 28, 2010

Re: waiting time. From experience, they'll find time to see you that day or the next day if it is serious.

Re: GP. GPs, especially of you have a good relationship with one, are great to re-explain things to you. It is amazing exactly how two different people can have two different interpretations of the same meeting. You'll both be under stress and a GP can help you work through it. You will benefit by having more people that understand what is happening to talk to. This is why the GP plays an important role in my life.

Admittedly, I live in a country with a public health service and Drs appts are cheap / free.
posted by dantodd at 5:08 PM on May 28, 2010

Adding to the chorus: I have one, which was discovered about four years ago when they were looking for the cause of chronic headaches. My GP took the absolute worst possible tack in telling me about it ("I have the results of your MRI, and... they found a small mass." [5 years come off my life during a three second pause] "It's a cyst, it's benign, you don't have to worry about it"). But, on further review, I discovered that my father also has one in the same general area (so there may be some aspect of heredity to it), and neither of us have ever had any problem with them. Dad's had his for sixty years with no issues, and I've had three different GPs and two neurologists tell me that mine is nothing to worry about. They're not even monitoring it--no followup exams.

I had a CT about ten years ago for a persistent headache (diagnosed with migraines), and I don't remember the doctor mentioning a cyst.

That's not all that unusual. When I had my original diagnosis made, it was because they were looking for anything out of the ordinary that could be causing headaches. When I had a separate scan done a few years later for an unrelated problem, the neurologist didn't mention it, and when I mentioned that a previous scan had shown one, he said something to the effect of "Yeah, I saw something like that, but it has nothing to do with your problem now." Unless your CT was targeted on the affected region, and the doc thought it was relevant to the problem you were having, it's very possible he didn't mention it to you.

Don't solely take our advice on this, of course, and check with your GP first, but I can at least tell you anecdotally that mine has been not-at-all a big deal.
posted by Mayor West at 5:08 AM on June 1, 2010

I have one of these, in the left middle cranial fossa (the most commonly occurring variant). It was found during an MRI that was ordered to rule out MS as the possible cause of peripheral neuropathy and episodic right-side weakness. The current working theory is that my symptoms are actually complex migraines.

What I have learned in my pursuit of answers: arachnoid cysts are a controversial subject in neurology. First, they're surprisingly common (between 1 and 2 in 100), and they appear in people who are perfectly healthy (that is, people without neurological symptoms). For this reason, they are usually considered an incidental finding, that is, not of clinical interest.

Having said that...

Sometimes they grow. Sometimes, they are really big, and sometimes they can unequivocally be associated with symptoms (for example, in the cases where they put pressure on the brain stem, or the optic nerve). And sometimes, when they are surgically removed, there are complications. A cyst that has been removed can, depending on how it was done, return.

Sometimes they are removed in the belief that they'll address certain symptoms, and it ends up not helping at all. In some cases, the surgery causes other problems. And then there are the people who have huge ones, and no symptoms whatever.

Now, since I have a history of migraines and am now experiencing some unpleasant sensory and motor symptoms, the possibility of a quick and permanent fix is very appealing. In doing my homework, I've run into a number of people in similar circumstances -- chronic migraine headaches, nasty auras -- who, in the course of their workups, find they too have an arachnoid cyst. In my case, the cyst is even located in the part of the brain that would correspond with the specific motor symptoms I am experiencing.

But that does not equal causation. The presence of an arachnoid cyst is a lousy predictor of whether the affected person will have symptoms. Yes, an arachnoid cyst is an abnormality, but so is a port wine stain. What matters is, is it causing you problems? And how would you know if it were? Not even neurologists know the answer to this question. There are too many confounding factors.

This is the dark side of modern imaging technology. It tells you about problems you didn't even know you had. Which is why an MRI is no substitute for a competent neurologist.

Even if you end up needing surgery it is a pretty straightforward procedure (as brain surgery goes)

It's still brain surgery. Any surgical intervention is risky, and for something like this, would really be a last resort. Monitor it, but if you have no symptoms, don't waste any energy worrying about it.
posted by rhombus at 1:48 PM on March 28, 2011