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Head injury is a major cause of death and disability in young, active population. It may introduce energy through the skin to the deepest structures of the brain. The entered energy may cause direct or primary injury, or result in other, secondary, events to the tissues. These are mechanical loads and are classified as static when the duration of loading is more than 200 ms and dynamic when less than this. The dynamic loads are further classified as impact if the injurious agent has contact with the head or impulsive when the load exerted to other body part/s results in damage to the brain by the change in speed of the head motion. Impact loads can either exert their effect with direct contact to the tissue or may cause inertial loads. The direct contact can cause deformation of the skull or induce energy stress waves to the head and brain. All of these events will result in tissue strain due to compression, tension, or shear. The strain will culminate in injury, which may be a scalp abrasion, laceration, skull fracture, or different kinds of intracranial traumatic lesions.

Arachnoid cysts are congenital lesions developing from arachnoid membrane. The incidence of arachnoid cysts in the general population is around 0.1% and their most common place is middle fossa. Arachnoid cysts usually present during childhood and are identified incidentally. When symptomatic, the most common presentation includes headache and seizure. The popular treatment for this lesion is surgery. In this case report, we describe a 12-year-old boy with a middle cranial fossa arachnoid cyst presenting with progressive headache, and bilateral subdural hygroma following a trivial trauma.Keywords: Bilateral Subdural Hygroma; Arachnoid cyst; Trauma by the arachnoid membrane [2,3].Arachnoid cysts are relatively rare. Their incidence in the general population is around 0.1% on the base of autopsy studies, with an estimated incidence between 0.5% and 1.6% [4]. Arachnoid cysts most commonly present during childhood and are usually identified incidentally. About 75% of intracranial arachnoid cysts presented before 3 years of age in one series [5]. The most common symptoms include headache and seizures.When there is hydrocephalus or intracranial hypertension the common treatment is surgery [6].Intracranial hypertension secondary to arachnoid cyst rupture especially in the subdural space is a rare clinical entity [7,8].In this case report, we describe a 12 year old boy with bilateral subdural hygroma and a middle cranial fossa arachnoid cyst presenting with progressive headache following a trivial head trauma. Based on our best knowledge this is not reported in the literature. Case PresentationA 12-year-old boy had a falling down while playing about 40 days before his admission to the hospital. His occiput was injured in the event.He had only dizziness immediately after trauma for 2-3 minutes but had no laceration, bleeding, nausea, vomiting, loss of consciousness (LOC), seizure, post-traumatic amnesia (PTA), etc. He had mild, left parietal beating headache that gradually changed to a generalized one associated with nausea and progressive non bloody vomiting, 3 days after trauma. Vomiting was correlated with eating.He was referred to neurosurgery clinic. On neurological examination his optic disk was flat and cranial nerves were normal. His meningeal signs were positive. Computed tomographic (CT) scan of brain ( Figure 1) showed a hypo-dense lesion in left middle cranial fossa with some squeezing of the ventricular system without midline shift. Brain magnetic resonance imaging (MRI) showed the lesion in the same place, widening Sylvian fissure, compressing temporal lobe and squeezing lateral ventricles. It had the same intensity as cerebrospinal fluid (CSF). There was also fluid collection in both frontal subdural spaces hypo-intense on T1 Figure 2 and hyper-intense on T2 images Figure 3. The findings were suggestive of Sylvian fissure arachnoid cyst and bilateral subdural hygroma.He was admitted to hospital for craniotomy, fenestration and marsupialization of the cyst into subarachnoid spaces, and evacuation of ...