Burst cyst in woman's brain misdiagnosed as migraines
A 24-year-old woman in Wales is sharing her story of recovery after undergoing emergency surgery caused by a series of headaches which turned out to be a cyst that had burst in her brain.
Emma Royle was initially diagnosed with migraines, she told the Daily Mail, however despite being given medication, her symptoms only became progressively worse. A lawyer in training, she went on to have shooting pains down one side of her body as well as random blackouts. Once, she briefly lost consciousness while was driving, a frightening incident that prompted another doctor’s visit where she learned that the optic nerve inside her eye was swollen.
The cause? An arachnoid cyst inside her brain that had burst, causing a build-up of pressure.
Within hours, Ms Royle was undergoing brain surgery to drain blood and reduce pressure on the brain.
“After the surgery, the consultant told me that I had been very lucky,” she recalled. “He told me that I had experienced virtually every symptom of chronic subdural haemorrhage.
“If I would have allowed my symptoms to go untreated for longer, he told me that I might have entered into a coma.”
After several physically and emotionally difficult months, Ms Royle is back at work and school. She decided to go public with her story in an effort to raise awareness of arachnoid cysts. While she’s now stable, she’ll have the cyst for the rest of her life.
Arachnoid cysts can be located anywhere in the brain or spine, says Dr. Gelareh Zadeh, neurosurgeon-scientist at Toronto Western Hospital, University Health Network and associate professor in the University of Toronto’s department of surgery.
The term “arachnoid” refers to one of three fine, delicate membranes that surround the brain and spinal cord.
Arachnoid cysts are often congenital, meaning present at birth, according to Johns Hopkins Medicine. They can also be caused by head injury or trauma. They’re four times more common in males than females.
“Arachnoid cysts can be thought of as pockets or collections of cerebrospinal fluid that have a thin wall made of arachnoid,” Zadeh says. “They represent approximately one percent of all brain mass lesions. Most arachnoid cysts are not symptomatic and can be followed with surveillance and routine imaging. They are readily seen on CT and MRI scans.”
If the cysts do cause symptoms, those signs vary. “If they become manifest during childhood, they can present with head enlargement or headache, lethargy, double vision, and developmental delay,” Dr Zadeh says. “In adults, they are more likely to cause seizures.”
Other symptoms include visible lumps on the head or spine, early onset of puberty, involuntary head bobbing and vision problems.
When there’s growth of the cyst or associated bleeding, as in Ms Royle’s case, surgery is recommended. An operation might involve opening the cyst to allow drainage of the fluid into the normal fluid spaces of the brain. Sometimes, a cyst can be shunted, meaning a tube is inserted into the cyst and remains in place allowing the fluid to drain away to be absorbed elsewhere in the body.
“The last option is to have an open craniotomy and removal of the cyst,” Dr Zadeh says. “These approaches will subside symptoms and resolve continuous growth of the cysts. The majority, however, do not require any surgery and can be monitored closely with imaging once a year.”
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