Dr. Nene Devavrat Harihar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I want to know how bad or serious is type II (Galassi) arachnoid cyst located on the left temporal lobe? Can it be responsible for mood fluctuations, depression and/or panic attacks?
There are no clear symptoms, but only mild depression (also had recent changes in life and my father died) and anxiety. No strong pain, only a minor one when my heart pounds fast. But I have to pay attention in order to feel it, it is very subtle. I am currently taking mild anti-stress natural medication and a quarter tablet of Betaloc-ZOK 50 mg in the evening to lower my pulse. I have done my MRI also.
Hi,
Welcome to icliniq.com.
There are no clear evidence in the literature favoring arachnoid cyst as a primary cause of any psychiatric disturbances. Having said that its size does affect the lobe functions if it is compressing it. So basically if you have symptoms that are not responding to the medical line of treatment then only you should opt for a surgical option.
Patient's Query
Thank you doctor,
In the diagnosis from the MRI center (not from an actual neurologist), it says that it is lightly pressing against the neighboring parenchymal tissue, hasno pain though.
Hi,
Welcome back to icliniq.com.
I would still suggest medical management for your symptoms and a psychiatric consultation rather than a neurosurgical procedure. These symptoms do not warrant any surgery at present.
Patient's Query
Thank you doctor,
If it would press sufficiently to affect the functions of that area, would I first feel the pain? I mean feeling no pain automatically means that it is not pressing dangerously and so it cannot affect the neighboring area? It also says that the cyst has no diffusion restriction. I went to the MRI just because I wanted to do.
Hi,
Welcome back to icliniq.com.
The brain is a painless structure. Only the coverings of the brain are painful. Compression and pain do not have a one to one relationship. Hence, headache is not always the first symptom of this compression. Arachnoid cyst is a benign entity. It anyways does not invade the surrounding areas. It is only the size and location that determines its effects on the brain. So if it is large enough it will cause problems with the functioning of that part of the brain which lies nearby.
Patient's Query
Thank you doctor,
Please take into account the fact that says there is no diffusion restriction. Also, since I had no head trauma or injury, is it safe to assume I was born with it? If this is the case, do the majority of these cysts evolve in time or just usually stay the same? Please provide more information. It helps me to calm down and I assure you I can comprehend most of it.
Hi,
Welcome back to icliniq.com.
Arachnoid cysts are diffusion free i.e. there is hypointensity on DWI due to freely moving protons that do not remain in phase when the next radiofrequency pulse is projected. Based on this MRI (magnetic resonance imaging) characteristic it is differentiated from an epidermoid cyst. Most arachnoid cysts are present since birth. Generally, they do not grow. Even if they grow it can be detected in serial MRI scans.
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