Types of cysts
The word “cyst” in an MRI report may hide different conditions. An arachnoid cyst is located between the membranes of the brain and is filled with cerebrospinal fluid; it is formed even before birth. Pineal cysts are a common finding in adults and are usually small and harmless. A porencephalic cyst forms at the site of dead brain tissue after a stroke, trauma, or perinatal lesion. A retrocerebellar cyst and dilated cisterna magna are often normal variants.
- Arachnoid cyst
- Pineal cyst
- Porencephalic and post-stroke cyst
- Colloid cyst of the third ventricle
- Parasitic cysts - echinococcosis, cysticercosis
- Cystic tumors and abscesses
Reasons
Congenital cysts arise due to the development of the membranes of the brain and are not associated with the behavior of the mother during pregnancy. Acquired cysts form after the death of a section of brain tissue due to stroke, hemorrhage, severe trauma, inflammation, or surgery. Parasitic cysts develop when infected with echinococcus or pork tapeworm - in regions where these parasites are found, this is important to consider. Some tumors also have a cystic structure, so if the picture is atypical, an MRI with contrast is performed.
- Disorders of intrauterine development of membranes
- Previous stroke or hemorrhage
- Traumatic brain injury
- Neuroinfections
- Parasitic diseases
- Tumors with a cystic component
Symptoms
Small cysts usually do not manifest themselves in any way, and headaches, dizziness or fatigue for which an MRI was done are most often not associated with a cyst. Symptoms appear when a large cyst compresses the brain or obstructs the flow of cerebrospinal fluid, causing hydrocephalus. A colloid cyst of the third ventricle can suddenly block the outflow of cerebrospinal fluid, which is manifested by a severe headache, vomiting, impaired consciousness and requires emergency assistance.
- More often - no symptoms
- Headache due to large cyst or hydrocephalus
- Nausea, vomiting
- Epileptic seizures
- Visual impairment
- In children - developmental delay, increase in head size
Diagnostics
The main method is MRI of the brain: it shows the size, location and contents of the cyst, compression of surrounding structures and the condition of the ventricles. If the cyst wall accumulates contrast, there is a nodular component, or the contents are atypical, an MRI with contrast is performed to exclude a tumor and abscess. If a parasitic cyst is suspected, serological tests are performed. If intracranial pressure is increased, the ophthalmologist examines the fundus of the eye, and during attacks, an EEG is prescribed. A control MRI is carried out after a period determined by the doctor to make sure that the cyst is not growing.
- MRI of the brain
- MRI with contrast for an atypical cyst
- Fundus examination
- EEG for epileptic seizures
- Serology for suspected parasitic cyst
- Control MRI in dynamics
Treatment and observation
Asymptomatic arachnoid cysts and pineal cysts are not treated; Often one control MRI is enough, and if the size is stable, observation is stopped. There are no medications that “resolve” brain cysts, and courses of vascular or nootropic drugs are not needed for them. Surgery is indicated if the cyst causes symptoms, grows, or interferes with the outflow of cerebrospinal fluid. Endoscopic connection of the cyst with the cerebrospinal fluid spaces, microsurgical excision, and less commonly shunting are used. A colloid cyst with signs of hydrocephalus is removed. Parasitic cysts are treated with surgery and antiparasitic medications.
- Observation for asymptomatic cysts
- Control MRI as recommended by a doctor
- Endoscopic cyst fenestration
- Microsurgical removal
- Shunting for hydrocephalus
- Antiparasitic therapy according to indications