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Case Clinic:
Arachnoid cysts

Munich Re’s medical experts respond to challenging underwriting scenarios

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    January 2024

    This series presents individual medical cases that feature challenging conditions, uncommon diseases, or an unusual presentation of symptoms. Below, we summarize a case, explain our research and analysis, and suggest an underwriting recommendation. Munich Re’s team of global medical directors routinely conduct rigorous analyses of the latest medical advances so that primary insurers and society alike can benefit from evidence-informed risk assessments. It is our hope that exploring compelling cases will foster a greater understanding of medical research and awareness of new medical innovations and emerging risks while ultimately expanding insurability.

    Case: Arachnoid cysts

    The Munich Re medical team investigated the insurability of a person who was seen by his doctor a year ago for headaches, and a subsequent MRI of the brain showed a 2 cm arachnoid cyst. The team asked, “Does the lesion need to be fully removed with benign pathology before an offer can be made?”  

    Munich Re medical's response

    • A cyst is a fluid-filled sac that can be located anywhere in the human body. An arachnoid cyst, one of the main types of benign cysts found in the brain, is filled with cerebral spinal fluid and appears within the arachnoid membrane, a thin membrane covering parts of the nervous system in the brain.
    • Brain cysts are relatively common but sometimes can resemble brain cancer. Often found incidentally, many are asymptomatic. However, they may grow slowly over time, putting pressure on vital brain structures and causing neurological symptoms. Rarely, bleeding may occur. 

    • Only 5% of arachnoid cysts are symptomatic and may include headaches, seizures, hearing loss, dizziness, nausea, and/or vomiting. Typical arachnoid cysts are between 3 and 6 cm in diameter. Most do not grow in size. 

    • The location of arachnoid cysts affects symptoms differently. Suprasellar cysts (generally those located above the pituitary gland) may cause obstruction, leading to hydrocephalus, an abnormal buildup of cerebrospinal fluid. 

    Final recommendation

    Munich Re determined that a careful review of the serial imaging studies would be required for any applicant with a history of an arachnoid brain cyst. If asymptomatic, with good confidence in the diagnosis, cyst size < 8 cm, and stable over one year, the risk may be accepted at standard rates. Careful consideration would be needed for those with worsening symptoms, enlarging size, and/or bleeding history. 
    Contact the author
    Gina Guzman
    Dr. Gina Guzman
    Vice President & Chief Medical Officer
    Munich Re Life US
    Tim Meagher
    Dr. Tim Meagher MD, FRCPC, FACP
    Vice President & Medical Director
    Bradley Heltemes
    Dr. Bradley Heltemes, MD, DBIM, FAAIM
    Vice President and Medical Director of R&D
    Munich Re Life US
    John F. White III
    John F. White III, MD, MBA, DBIM, FLMI
    2nd VP Medical Director
    Medical Director, Munich RE US
    The information provided herein is for general information purposes only and should not be relied upon as professional advice. Munich Re, and its employees, directors, officers, and representatives do not warrant, represent or guarantee the accuracy, completeness, or currency of any of the information provided herein and accept no liability whatsoever arising in any way from the use of or reliance on such information, including liability for direct, indirect, special, incidental or consequential damages. © 2024 Munich American Reassurance Company. All rights reserved.