A refractory arachnoid cyst presenting with tremor, expressive dysphasia, and cognitive decline

BACKGROUND Arachnoid cysts are common incidental findings on intracranial imaging, although they are rarely symptomatic. CASE DESCRIPTION We present a case of a 49 year-old woman with a recurrent left supraorbital arachnoid cyst who developed staring spells, expressive dysphasia, and tremor after cyst fenestration and cystoperitoneal shunting. Her symptoms resolved after removing the shunt valve and creating a valveless system. The case is discussed and the literature reviewed. CONCLUSION We present a case of a recurrent arachnoid cyst that developed worsening and new symptoms after cysto-peritoneal shunting with a programmable valve, which reducing the pressure in the cyst resulted in remarkable resolution of her symptoms.