Ganglion Cyst

Ganglion cyst is a non-cancerous bump or mass that forms under the skin. A ganglion cyst usually forms on the top of the wrist or the underside of the wrist. Ganglion is a Greek word that indicates 'a knot of tissue'. Ganglion cysts are also known to develop on the joints of the shoulder, elbow, knee, hip, foot or ankle. Ganglion cysts are noticed more commonly among women. When connective tissues around a joint become inflamed and fill with fluid, a ganglion cyst is formed. Ganglion cysts formed on the fingers can lead to deformed finger nails.

The ganglion cyst tends to grow in size when there is more activity. Large ganglions are often unsightly. Occult ganglions are smaller and remain hidden under the skin. Ganglion cysts are soft and moveable. This lump becomes larger in persons who are more active like gymnasts and apply pressure on the nerves passing through the joint. Occupational factors such as repeated pressure or excessive overuse of certain joints can lead to the formation of ganglion cysts.

A doctor will examine the lump and check its size and if there is any tenderness. Usually ganglion cysts are painless but there may be slight tenderness that can affect movement of the affected bone. X-rays or ultrasound may be taken to rule out tumors, arthritis or other bone problems. In some cases, ganglion cysts eventually disappear by themselves. But they may recur. In cases of painful ganglions, the fluid will be aspirated and drained. Persons suffering from osteoarthritis may notice mucous cysts - a type of ganglion cyst that needs surgical removal. The surrounding area is numbed and the fluid is taken out with a thin needle. Often NSAIDs are prescribed to tackle any shooting pain or ache associated with ganglion cysts. Ice packs can give some relief.

Bartholin's Cyst

The Bartholin's glands are found as a pair on both sides of the vaginal opening. These pea-sized glands help in keeping the vaginal lips moist with their fluids. Bartholin's Cyst is a condition when there is a lump that is formed at the opening of the vagina due to clogged Bartholin's glands. A woman suffering from Bartholin's cyst suffers pain and tenderness near the vaginal opening. There is redness and painful lump near the vaginal opening that causes discomfort while walking and sitting. The cyst can get infected and become an abscess. E-coli, gonorrhea and chlamydia can lead to such a situation. A doctor may drain the cyst to allow for faster healing. A sitz bath (soaking in warm water) can aid faster rupture of the Bartholin's cyst. Antibiotics are prescribed if there is any infection. Good personal hygiene and practicing safe sex can help keep this uncommon condition at bay.

Syringomyelia

Syringomyelia is a generic term referring to a neurological disorder where a cyst or cavity is formed within the spinal cord. This cyst called syrinx can expand and elongate over time destroying even the spinal cord leading to pain, paralysis and weakness due to the damage caused. Syringomyelia can lead to inability to feel extremes of hot or cold especially in the hands.

Signs and symptoms of Syringomyelia

Syringomyelia symptoms usually develop slowly over time, and symptoms generally may begin between ages 25 and 40. The symptoms could vary depending upon the extent and location of the syrinx in the spinal cord. Pain is the predominant symptom in Syringomyelia as the nerves are directly under pressure. Patients report pain in the neck, upper back, and shoulders. This is referred to as the cape effect of Syringomyelia - pain where a cape is draped over the shoulders.

There could be pain in the chest, stomach or lower back region for those with a syrinx in the thoracic region of the spinal cord. Neuropathic pain is common among Syringomyelia patients and can be very difficult to treat. Many with Syringomyelia may lose strength and develop numbness in their arms and legs. Controlling body temperature, stiff muscles and loss of bladder and bowel control are other challenges of Syringomyelia. There could be a combination of symptoms experienced by each patient. Symptoms begin in young adulthood. Though the signs of the disorder tend to develop slowly, there could be sudden onset of cough and strain. Some people develop a large syrinx without any symptoms. These people become symptomatic suddenly and deteriorate rapidly.

Causes of Syringomyelia

Syringomyelia is a result of something else and not a disease in itself. The most common cause is a Chiari malformation. Syringomyelia can also result from a spinal cord injury such as a car accident or a fall. Post traumatic Syringomyelia can form months or even years after such an injury. Tumor or mass in spinal cord can also result in Syringomyelia.

Syrinx formation

Although there have been several theories on this, the most recent one states that the cerebellar tonsils act like a piston and beat down the spinal area with every heartbeat. The piston motion forces the cerebrospinal fluid into the spinal cord where it forms a syrinx. However, the reason for the pressure higher inside than outside the fluid does not match CSF.

Diagnosis of Syringomyelia

Spine MRI can show the presence of a syrinx. Usually MRI of the entire spine is done if Chiari malformations are found. CT scan uses a series of X rays to create a detailed view of the spine and spinal cord.

Treatment of Syringomyelia

Most surgeons recommend surgery of some type. While some surgeons recommend surgery anytime there is a syrinx, others monitor the situation with routine MRI and neurological exams. For Chiari related Syringomyelia, surgery will reduce the syrinx, or at least will prevent increase in most cases. Surgery doesn't always effectively restore the flow of cerebrospinal fluid, and the syrinx may remain, despite efforts to drain the fluid from it.

For those with symptoms of an active syrinx, it may eventually lead to paralysis. For the others without symptoms, the future is less clear and uncertain. Surgery can reduce the pressure on the brain and spinal cord, restore the normal flow of cerebrospinal fluid and resolve Syringomyelia.

Draining the syrinx: The doctor will surgically insert a drainage system called a shunt and drain the syrinx. It consists of a tube with a valve that is flexible from the syrinx flowing in the desired direction. One end of the tube is placed in the syrinx and the other is placed in another area of the body such as the abdomen.

Removing the obstruction: In case a tumor or a bony growth is hindering the normal flow in cerebrospinal fluid, surgically removing the obstruction may restore the normal flow and allow fluid to drain from the syrinx.

Correcting the abnormality: In case a spinal abnormality is hindering the flow of cerebrospinal fluid, surgery to correct it, such as releasing a tethered spinal cord, may restore normal fluid flow and allow the syrinx to drain.

Recovery post surgery

This will vary from one individual to another, but will depend largely on whether there is any permanent damage from the syrinx. In some cases it may take years to get better and stronger. Even after successful surgery, the syrinx may take a year to collapse and may not go away completely. Often recovery can be a series of ups and downs, with long periods of improvements punctuated by temporary setbacks.

Post Surgical Care

Follow-up care after surgery is critical as chances are Syringomyelia may recur. Regular examinations with the doctor, including periodic MRIs to assess the outcome of surgery are necessary. The syrinx may grow over time requiring additional treatment. Even after treatment, the syrinx can cause permanent spinal cord and nerve damage.