27 Apr 2018

c7-t1 perineural cyst


Hi all, was taking to a person recently and they said their Neuro consult never mentioned that a c7-t1 perineural cyst showed up on their MRI and asked me would this condition contribute to the sensations they are feeling at present, they have MS! They managed to see their results of mri.now my looking into this condition is that it would but before I go back and contradict the professional and send this person into a spin, I am seeking advice here.also what would be the intervention they would need in this case!any insight is always welcome D


That's at the base of the neck (that "c7-t1").  A cyst is not something that usually is of much harm in and of itself, but here it might crowd the channel the spinal cord is in.  One would have to look at the images to say much; it depends on how big it is, and where it's positioned.  There's also the question of whether, even if it doesn't seem to be crowding the spinal cord at the moment, it might when the neck was bent -- in which case you'd expect to see the symptoms get much worse then.As for correlation with symptoms, there are tables of where on the spinal cord various nerves come out, which can be looked at to determine whether someone's symptoms are consistent with spinal cord problems at any given point.  If a nerve comes out above a certain level, symptoms involving it can't be caused by a problem at that level.

Thanks Norman.... This girl was wondering why it wasn't even mentioned to her... She is experiencing a lot of sensations and they are putting it down to MS...  I just have a feeling it's the cyst that's causing them which has nothing to do with MS... These types of cysts are certainly not next or near anything I know.  I will just tell her to ask neuro consultant to explain why they feel this cyst has nothing to do with the sensations she is having...is there anything that can be done other than draining/removing it?sorry i know this has nothing to do with CPn but this girl is worried and I am trying to talk to her about the whole Cpn = MS  thing and bring her round to rhis website.again thanksD

The Greatest Risk of all is Not taking the Risk...

The neurologist may not even have looked at the images himself; it's quite common for neurologists just to read the report, and never look at the images.  But you (or she) likely can; get a CD of the results, and look at them.  These CDs normally come with a Windows application on them that will show the images.  Even if you don't know the MRI lingo (T1, T2, FLAIR, etc.), a cyst should be pretty obvious.  (And if it isn't obvious, it's probably too small to cause problems.)  Run a Google Images search for "MRI cyst" to see what you'd be looking for.With 24/7 access to the raw sensory data, a thinking patient can do a lot better job at sorting out which symptoms are due to what than a neurologist can.

Perhaps they'll prescribe antibiotics for the cyst and she'll get a head start on the wholle process.  Cool(If only it were so easy...)

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Agreed, it likely isn't infected.  Internal cysts are a 'different animal' in most cases.  Even when I had an ovarian cyst, antibiotics weren't prescribed for it.  (Surgery, yes, but no antibiotics until post-surgery.)

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

Hi Norman,thanks for that information!i can access my own mri results with a program I got for my Mac... As the company that carry out the mri send out the cd to me also... The benefits of going private..(-:.. I also get access to the report that the consultant radiographer writes up for the Neuro consultant So that's find for me.i do know that this girls cyst is 8mm as that is what was on her report she got access to...would you recommend. surgery? Sorry for for all the questions but I am a novice when it comes to this area of healthcare and I would like to help her out..thanks againD

The Greatest Risk of all is Not taking the Risk...

Surgery on the spinal cord is hugely dangerous.  Removing a cyst that is somewhere near the skin is not at all a big deal; but this cyst is buried inside bone and layers of muscle, fascia, and such -- all of which, once cut apart, never quite heals the way it used to be.  Surgery always carries a risk of infection, which again is a bad risk here.  So this cyst is not something to go after unless she's sure it's causing problems, and maybe not even then.8mm is pretty large; the whole spinal cord is about 10mm to 15mm in diameter.  Still, it's the images that'd really tell you whether it's crowding the cord.  (There's normally a fair bit of space around the cord, which a cyst could expand into.)  Looking at the images, one can think mechanically about whether it is causing a problem: for instance, "okay, it's on the right side, so if I tilt my neck to the right, that should make it poke into the spinal cord more, which explains why I get tingling in my feet then"  (that may not be correct reasoning; I offer it just as an illustration), or "this cyst isn't spherical, but rather is elongated in the vertical direction, so there must be pressure on it from the side, so it's probably crowding the cord".Anyway, this would be a pretty poor website if we had to stick entirely with Cpn and couldn't consider any of the possible alternative causes of symptoms.  There is a famous medical saying by Osler, "The physician who knows syphilis knows medicine".  That is, syphilis messes with so many different parts of the body, and causes such varied symptoms, that to really treat it appropriately you have to know all the other disorders it can be confused with, which is pretty much the whole of medicine.  A similar thing might be said about Cpn.  So no apologies are needed.Unfortunately you are in the role of doctor here; it is she, rather than you, who has 24/7 access to the raw sensory data, and thus is in the best position to do the mechanical reasoning.  Some people have a taste for this sort of thinking; others would rather die than engage in it.

By the way, it occurs to me that though I've been assuming this cyst is inside the spinal column, that may not be the case.  It might be outside, on a nerve emanating from the spinal column.  In that case it'd be much easier to deal with, and also to diagnose problems from (just press on it and see if it causes symptoms).

No apology necessary, Darren.  Emergencies happen.  Cool  You've got a pool of knowledge here and it should point you in the right direction in short order.

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

This is true: a cyst on the outside of the spinal column can be dealt with fairly easily if needed but operating inside is very dangerous.  An orthopaedic surgeon once told me that my troubles were due  to congenital spinal stenosis, most common with achondroplastic dwarfs(!) yet luckily he wouldn't operate on me because of the danger of my ending up paralysed.................Sarah

Completed Stratton/Wheldon regime for aggressive secondary progressive MS in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.