A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a Pediatric Patient

Bryden, Anne M.; Majors, Natalie; Puri, Vinay; Moriarty, Thomas

doi:10.3390/children8020078

Cited by 6 publications

(9 citation statements)

References 14 publications

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“…1,9,10 The risk of rupture is estimated to be less than 0.04% per year and is typically provoked by physical exertion or after a traumatic insult. 1,2,4,6,8,11 Spontaneous cyst ruptures, as seen in this patient, are exceedingly rare. According to a recent report, only 57 cases of spontaneous rupture have been documented in the literature.…”

Section: Discussionmentioning

confidence: 68%

“…7 While most arachnoid cysts are benign, indolent lesions that remain clinically asymptomatic for the entirety of a patient's lifespan, 1,7 an estimated 5% become clinically apparent and present with signs and symptoms of increased intracranial pressure and mass effect such as headache, focal neurological deficits, and seizures. [1][2][3]8 Rarely, they can cause significant and urgent clinical problems, most notably cyst rupture, characterized by rupturing of blood vessels around the cyst wall or tearing of bridging veins within the cyst cavity. 1,9,10 The risk of rupture is estimated to be less than 0.04% per year and is typically provoked by physical exertion or after a traumatic insult.…”

Section: Discussionmentioning

confidence: 99%

“…Additional complications after surgical decompression include hydrocephalus, subdural hematomas, intraparenchymal hemorrhage, cerebral edema, infection, and seizures. [1][2][3][4][5]15 Patients should be followed and monitored with imaging at appropriate time intervals. There is no consensus in the literature due to the rarity of surgery for ruptured cysts, but we follow the general principle of near-term and longer-term imaging and neurological assessment to monitor for any symptomatic cyst recurrence and/or growth.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of an arachnoid cyst in an adult: illustrative case

Leavitt

Nanda²,

Stemmer‐Rachamimov

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Arachnoid cysts are common intracranial mass lesions frequently discovered as incidental findings on radiographic imaging. It is routine practice to monitor these lesions as a large majority remain stable. Although traumatic cyst rupture is a known risk, it is rare for patients to present with spontaneous rupture. OBSERVATIONS The authors report the case of a 32-year-old patient who required emergent neurosurgical intervention for spontaneous rupture of a left hemispheric arachnoid cyst. LESSONS Patients with ruptured arachnoid cysts can present with vague, nonspecific symptoms that may delay diagnosis. If not diagnosed and treated promptly, arachnoid cyst rupture can progress to a neurosurgical emergency as the subdural collection may cause extensive mass effect and even cerebral herniation.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous rupture of an arachnoid cyst in an adult: illustrative case

Leavitt

Nanda²,

Stemmer‐Rachamimov

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…However, the most common location of an arachnoid cyst is the middle cranial fossa, occurring in over 50% of cases. While the majority of patients with arachnoid cysts are asymptomatic, arachnoid cysts may present with headaches, seizures, and neurological deficits [ 2 ]. Arachnoid cysts may get ruptured in the setting of head trauma.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Rupture of Arachnoid Cyst in a Child: A Rare Case Report

Almousa¹,

Alotaibi²,

Wadany³

et al. 2023

Cureus

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An arachnoid cyst is a benign lesion filled with cerebrospinal fluid that usually develops in the middle cranial fossa. The arachnoid cyst may become symptomatic if it has a large size or when it gets ruptured. Spontaneous rupture of an arachnoid cyst is a very rare complication. We report the case of an 11-year-old girl who was brought to the emergency department with a complaint of a progressive headache that was associated with vomiting. On examination, she was found to have papilledema. Subsequently, magnetic resonance imaging of the brain was performed to exclude any space-occupying lesion. The scan demonstrated a right extra-axial temporal lesion, measuring 7.8 x 5.4 x 4.9 cm on maximum dimensions, along with an extension to the right cerebral convexity in a crescentic shape. The lesion follows the signal intensity of cerebrospinal fluid on all sequences and exhibited no post-contrast enhancement or restricted diffusion. The lesion exerted a mass effect in the form of compression of the right temporal lobe. These findings were consistent with an arachnoid cyst with subdural hygroma. The patient was referred to the neurosurgery team. Then, the right temporal arachnoid cyst was drained through the right temporal craniotomy and the subdural hygroma was drained through a frontal Burr hole. The patient was seen after one month in the pediatrics clinic and was completely asymptomatic.

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“…This event seems to be peculiar of SACs where the risk of rupture is higher compared with intracranial arachnoid cysts located elsewhere [6,7]. The cyst rupture raises a great interest among the scientific community because of the possible emergency implications and the variable clinical presentation and course, as demonstrated by the large number of reports published even in recent years [8][9][10][11][12][13][14][15][16]. Moreover, the management of ruptured SACs still represents a controversial problem for neurosurgeons as far as the surgical indication and the type of treatment are concerned.…”

Section: Introductionmentioning

confidence: 99%

Ruptured Sylvian arachnoid cysts: an update on a real problem

et al. 2022

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Purpose Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition. Methods A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations. Results A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated. Conclusions The “spontaneous” or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.

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A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a Pediatric Patient

Cited by 6 publications

References 14 publications

Spontaneous rupture of an arachnoid cyst in an adult: illustrative case

Spontaneous rupture of an arachnoid cyst in an adult: illustrative case

Spontaneous Rupture of Arachnoid Cyst in a Child: A Rare Case Report

Ruptured Sylvian arachnoid cysts: an update on a real problem

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