Arachnoid cysts as a cause of dementia in the elderly

Abstract

Arachnoid intracranial cysts are benign lesions which until recently have been considered to be quite uncommon. They are benign congenital lesions usually discovered at an early age. We have recently treated two patients with advanced age and arachnoid cysts, unusual due to their location and extent. Both of them presented clinically with an organic dementia syndrome with some similarities to that seen in normal pressure hydrocephalus. Both recovered fully after surgery. We review the literature and try to emphasize the clinical differences between arachnoid and the more rare neuroepithelial cysts.

A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults

“…They can be located along the craniospinal axis, with a predilection for the temporal fossa 1. They may present with specific symptoms, such as sensorimotor symptoms corresponding to the location of the cyst, but more often they yield unspecific symptoms (eg, headache or dizziness, or symptoms related to suboptimal cerebral function, such as epilepsy or impaired cognition) 2 – 10…”

Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome

“…[1][2][3][4][5][6][7][8][9][10][11] Is it possible that these symptoms and findings can be explained simply by an increase in intracranial or intracystic pressure, or are other more complex mechanisms at work?…”

The Acetazolamide Challenge: A Tool for Surgical Decision Making and Predicting Surgical Outcome in Patients with Arachnoid Cysts

“…1 They may present with specific symptoms, such as sensorimotor symptoms that correspond to the location of the cyst, or nonspecific symptoms like headache, dizziness, epilepsy, or impaired cognition. [2][3][4][5][6][7][8][9][10][11] Their prevalence in adults is $ 0.2 to 1.7% with 2.6% in children. 4,[11][12][13][14][15] In patients with asymptomatic ACs, conservative management with or without serial neuroimaging and neuropsychological follow-up has been advocated, even for those in whom neuroimaging suggests raised intracranial pressure (ICP) 1,2,7,8,10,12,[16][17][18][19][20] from mass effect with compression, shifting, or effacement of cerebral structures.…”

“…[2][3][4][5][6][7][8][9][10][11] Their prevalence in adults is $ 0.2 to 1.7% with 2.6% in children. 4,[11][12][13][14][15] In patients with asymptomatic ACs, conservative management with or without serial neuroimaging and neuropsychological follow-up has been advocated, even for those in whom neuroimaging suggests raised intracranial pressure (ICP) 1,2,7,8,10,12,[16][17][18][19][20] from mass effect with compression, shifting, or effacement of cerebral structures. For those with moderate and unspecific symptoms, surgical treatment for ACs is a controversial issue, with many authors expressing reluctance to operate on patients unless the symptoms were dramatic [21][22][23][24][25][26][27][28][29][30][31] while others have been more liberal and suggested that surgical cyst decompression improved 86% of patients with complication rates of 17%.…”