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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.

Electroretinography

Electroretinography or ERG is an eye test used to detect the abnormal function of the retina. The rods, cones and the ganglion cells of the eyes are examined during this test. An electrode is placed on the cornea to measure the electrical response to the light in the retina and the back of the eye. This test helps identify any defects in the retina and can help in identifying if retinal surgery is required.


ERG Procedure

Patient's eyes are dilated and anesthetic drops are placed on the eyes. Eyes are kept open using a speculum and an electrode is placed in the eye. Another electrode is placed on the skin. The patient is made to watch a standardized light stimulus or flash ERG. The signal received is measured according to its amplitude. The readings are taken when the room is normally lit and when the room is dark. If the tests are normal, it will display a normal A and B pattern for each flash.

Abnormal results can indicate:




Ganglioglioma

First described by CB Courville in 1930, Ganglioglioma comes from the Greek work 'ganglion' meaning know, and the Greek word glia meaning glue and the Greek word oma meaning tumor. Strung together, the words mean 'glue knot tumor'. Ganglioglioma is a rare type of tumor that originates from nerve cells and develops in the central nervous system. The growth of the tumor and its symptom may vary depending on its exact location and size.


Ganglioglioma accounts for 2% of all primary intracranial tumors and up to 10% of primary cerebral tumors in children. Ganglioglioma can occur anywhere in the brain and rarely in the spine as well. Most Gangliogliomas are located on the sides of the brain by the ears and in children about 70% are located above in a part in the brain known as the tentorium - a membrane that separates an area in the back, lower part of the brain known as cerebellum, from an area in the back, upper part of the brain known as occipital lobes. Ganglioglioma can also occur in the brain stem, located below the cerebellum that controls many important motor, sensory and reflex actions.


Symptoms

The signs and symptoms depend on the location of the tumor and how fast it can spread, depending upon the age of the patient. In those above ages 10-20, symptoms include:


  • Seizures
  • Involuntary muscle movements
  • Decreased awareness of the environment.

If Gangliogliomas appear in the ear lobes, it can lead to seizures and symptoms such as:


  • Loss of awareness
  • Abnormal sensations
  • Feeling of being detached from oneself
  • Involuntary muscle movements

If Gangliogliomas are present in the cerebellum, signs and symptoms include:


  • Impaired motor coordination
  • Headache
  • Buildup of cerebrospinal fluid in the brain

Causes

Gangliogliomas are caused by abnormal glial cells. Glial cells support and maintain other cells. Gangliogliomas are partly made of neurons or nerve cells in various degrees of abnormality. In Gangliogliomas are also found supportive tissue known as stroma, which contain fibers and blood vessels. Fibers are flexible, threadlike objects found outside the cells. In Gangliogliomas are neurons, glial cells and stroma in abnormal shape, size and appearance. The more the cells change in structure, size and appearance; the more harmful the tumor is.


Diagnosis

Initially the seizures associated with Ganglioglioma lead a patient to seek medical help. The doctor uses various techniques to diagnose the cause of the seizures. Pictures of the brain are taken and CT scans done to get clear and detailed pictures. MRI scans are sensitive and specific at detaching a tumor and when contrast is injected into the person's body during the scan. About 50% of Gangliogliomas are detected when contrast is used. MRI scans can also detect if there are any cysts in an abnormal lump, swelling or sac that contains fluid and is covered with a membrane.


But it is not until a sample of the tumor is removed during surgery that it can be tested in a laboratory and definitively stated that it is Ganglioglioma. In a laboratory abnormal neurons are stimulated and the irritation produces a protein called synaptophysin and glial fibrillary acidic protein. There are special stains applied to the neurons in the lab to detect the presence of these proteins. However regular x rays do not help in diagnosing Gangliogliomas as they are best at detecting bones and can only detect if calcium is near the Ganglioglioma.

Gangliogliomas are common before age 20 and about 60% of people who are diagnosed with Ganglioglioma are adolescents and adults younger than age 30. However, even those as young as 2 or as old as 70 have been known to develop Ganglioglioma. It affects equal numbers of males and females. In the US approximately 1 to 2% of brain tumors are Gangliogliomas. About 10% of all primary brain tumors in children are Gangliogliomas.


Treatment

Surgery is most often done to remove Ganglioglioma tumor. After the tumor is removed, radiation therapy is not needed unless the tumor shows signs of growing back, which is rare. Radiation is aimed at tumors to destroy or weaken them. Prognosis of people with Ganglioglioma is excellent as it is easy for surgeons to remove them as they are typically found in one place and can be separated from the brain tissue. Most get cured after surgery and chance of tumor coming back after it has been totally removed is rare.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 19, 2019