Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing's reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma.

Objectives: To study the epidemiology of drowning among children cases reported at Sultan Qaboos University Hospital in Oman. Methods: We conducted a retrospective study of the patients who were presented at emergency department with the history of drowning over a period of 10 years from January 2008 to December 2017. Patients with age 1 to 18 years were included in the study. The data including demographics, timing and location of drowning, season, adult supervision, swimming ability, medical risk factors, duration of submersion, on spot resuscitation, emergency medicine department assessment, hospital management and outcome were collected from electronic hospital information system using a preformed proforma. Outcome was categorized into either full recovery, severe neurological injury or brain death based on the pediatric cerebral performance category (PCPC). A good outcome represents to a score of 1-3 points and PCPC 2 of 4-6 points corresponds to poor outcome. We calculated correlation for all variables with the outcome by using chi square and fisher exact tests. P value of <0.05 is taken as significant value. Results: A total of 74 patients were included in the study. Of them, 54 (73%) were male, children of less than six years of age were 47 (63.5%). More than 50% of drownings happened in outside swimming pool, 21 (28.4%) of patients were unsupervised during incident and 39 (52.7%) required cardiopulmonary resuscitation. Out of all studied subjects, 3 (4%) were brain dead and 2 (2.7%) developed severe neurological injury. On univariate analysis, the following variables were statistically significant (p<0.05) predicting the poor outcome like lack of adult supervision, duration of submersion >10 minutes, asystole, Glasgow Coma Scale <8, temperature <35c, PH <7, anion gap >20, blood glucose >10 mmol/L, abnormal chest x-ary findings, rewarming, cardiopulmonary resuscitation, intubation, inotrope support and pediatric intensive care unit admission. Conclusion: This study suggests that children especially male below 6 years of age without swimming ability need strict supervision next to body of water. Furthermore; preventive measures might include raising community awareness about the risk factors of drowning, commencing public CPR lessons and strict pool safety regulation by related authorities.

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