Dear Dr. Joshua,

I had a full brain MRI and was told I have hydromyelia of the middle of my spinal canal. it is a smaller syrinx and and I have had this for 4 years but it has gotten a little larger now. I am experiencing tingling, numbness fingers, toes. I have burned my arm and not felt it etc. I do understand that the syrinx is in an area that you do not really want to repair it for fear of causing more damage than you would do than leaving it alone. I had decompression surgery already. I was also told that I have a choroid plexus cyst within the right temporal horn. I have extreme migraines, vomiting, imbalance, etc. Can this be caused by the cyst? Do you monitor the cyst? Can the cyst become a tumor? Thank you for your time! Just a little nervous with all this news at once. I am 48 years old. I have Arnold Chiari Malformation, Pseudo Tumor Cerebri, Trigeminal Neuralgia thrown in to boot.

Doctor Sinuhe Answers:

Thanks for your question. You describe several different conditions, all of which alone would require a thorough discussion; Chiari Malformation, Syrinx and the Cyst, the first two of which are probably related. Since it is not possible to address them all properly here and especially as I do not have enough information to comment specifically on your case (a thorough history and a physical examination is needed - as well as MRI scans), I’ll provide some general talking points that might apply to situations somewhat similar to yours, so that you may discuss the matters further with your own neurosurgeon.

Chiari malformation as such may cause many of the symptoms you describe, such as headache and imbalance. In Chiari Type I malformation the cerebellar tonsils are elongated and pushed down through the opening of the base of the skull (foramen magnum), which may block the flow of cerebrospinal fluid (CSF). The brainstem, cranial nerves, and the lower portion of the cerebellum may be stretched or compressed. Therefore, any of the functions controlled by these areas may be affected and numerous symptoms may appear.

Chiari type I Malformation is frequently associated with syringomyelia (which may have other causes as well), probably because the blockage of CSF flow by the malformation in the foramen magnum region may cause a syrinx (fluid accumulation) to form inside the spinal cord (syringomyelia), when normally there is practically very little or no fluid inside the cord. Syringomyelia typically causes symptoms like those you describe, such as dissociated sensory loss, tingling and numbness. It is treated by treating the actual Chiari Malformation and also by local decompression of the syrinx. Sometimes a tiny tube is placed inside the canal to drain cerebrospinal fluid out, but not always does it ease the symptoms.

The fetal brain may create choroid plexus cysts as a normal part of development. They are temporary and usually are gone by the 32nd week of pregnancy. It is, however, believed that many adults have one or more tiny cysts. They have no impact on an individual’s health or development or learning. There is no known danger of them becoming a tumor, but obviously it is impossible for me to differentiate your cyst form a neoplastic tumor. Choroid plexus tumors are rare (account for less than 1% of all intracranial tumors), most are histologically benign, often cause symptoms of increased intracranial pressure (such as headache and vomiting) and are often treated with surgery. Now, if your doctor has said that you have a simple cyst and do not require surgery, I’m not trying to second guess him, but you should probably talk with him again about your worries.

Keep us posted on what he says!