Q. Does frequent headache and depression with a normal MRI report require biopsy or surgery?

Answered by
Dr. Muhammad Shoyab
and medically reviewed by Dr. Chithranjali Ravichandran
This is a premium question & answer published on Jul 21, 2022

Hello doctor,

Few days back I was suffering from severe headache and depression. I have a Dicom file MRI report of the brain and need detailed information about the MRI.

Kindly help.



Welcome to

I read your query and understand your concern. I can interpret that you have been suffering from headaches and depression. After reviewing the MRI images in detail (attachment removed to protect patient's identity), I found that the MRI findings are within normal range, except for a prominent fluid-filled space behind the brainstem, which is called cisterna magna. Cisterna magna is a normal variant and is of no significance in most cases. However, in very rare cases, cisterna magna can produce headaches by increasing intracranial pressure. In that context, I can assure you that the brain MRI is normal. Hence, the medications you have been prescribed may be appropriate and beneficial.

Thank you.

Hello doctor,

Thank you for the diagnosis. Some of the doctors in my country said " it needs surgery," and others said " no need for surgery." What will you recommend? Also, do I need to do a biopsy to see if it is a tumor or not? I would be grateful if you could answer those questions.



Welcome back to

It is very unlikely to be a tumor, so a biopsy is not required. About the surgery, neurosurgeons are the ones best qualified to voice that opinion. Still, in my opinion, the surgery is rarely required, only if the cisterna magna becomes too big or produces significant intracranial hypertension. From the MRI, the cisterna is just prominent and not "too big." Also, no MRI evidence of raised ICP (intra cranial pressure) exists. From a technical point of view, ICP may be measured by a lumbar puncture for confirmation, but the decision for such a procedure is to be made by the neurologist/neurosurgeon. So, I think you can take their consultation for further decision-making and continue with the present medications till then.

Thank you.

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