Arachnoid cyst with spontaneous intracystic hemorrhage and associated chronic subdural hematoma: A case report

Kieu, Hung Dinh; Le, Tam Duc; Tran, Trung Quang

doi:10.1016/j.ijscr.2021.105789

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…From the literature, it may be postulated that nontraumatic CSDHs in young patients could be associated with spontaneous AC-related hemorrhage. [ 1 , 2 , 7 , 8 , 10 , 11 , 14 , 15 ] The etiologies of hemorrhage in subdural and/or intracystic spaces include: (1) rupture of bridging veins by tearing of the outer wall of the AC;[ 7 , 14 ] (2) rupture of unsupported blood vessels around the cyst wall;[ 7 , 8 ] and (3) rupture of leptomeningeal vessels at the base of the cyst. [ 7 , 8 ] To the best of our knowledge, there are no reported cases of nontraumatic SDH followed by AC hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…[8] However, the optimal treatment strategy for CSDH with AC hemorrhage is still controversial. [12] Reported successful initial treatments are CSDH drainage by burr-hole surgery, [10,12] CSDH evacuation and AC membrane removal, [12,15] and CSDH evacuation and AC membrane fenestration. [4,12,15] Diagnoses, etiologies, and treatments in our patient e AC existed before CSF hypovolemia in our case.…”

Section: Treatmentsmentioning

confidence: 99%

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Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Shimizu

Ito

Higuchi

2022

Surgical Neurology International

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Background: Diagnosing the cause of headaches can be challenging. Even if intracranial lesions are found in a patient, careful assessment is essential for diagnosis, and treatment strategies will differ for each etiology. Case Description: A 16-year-old boy presented with sudden-onset headache which had lasted for 2 days. His headache was aggravated in the orthostatic position. The patient denied recent head trauma. He had been diagnosed with an arachnoid cyst (AC) in his right middle cranial fossa. Computed tomography (CT) revealed bilateral subdural effusions and slit-like lateral ventricles with no significant changes to the AC. After intravenous hydration followed by 2 days bed rest, his symptoms abated. He was diagnosed as having suffered spontaneous cerebrospinal fluid (CSF) hypovolemia. One month later, the patient experienced recurrent gradual onset headache and vomiting. CT revealed chronic right side subdural hematoma (SDH) with intracystic hemorrhage, which resulted in the elevation of intracranial pressure. An urgent hematoma evacuation was performed. He became symptom-free immediately after surgery. Postoperative follow-up CT showed no change in the AC and no recurrence of SDH. The lateral ventricles and subdural space were normal in size. Conclusion: We report a case presenting multiple types of secondary headaches, which were caused by intracranial hypotension or hypertension, with different etiologies. These were spontaneous CSF hypovolemia, nontraumatic intracystic hemorrhage form of AC, and nontraumatic chronic SDH. Although lesions seen at the time of initial diagnosis did not need surgical treatment, careful observation and repetitive imaging assessments might be useful for discovering unsuspected additional etiologies requiring surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Shimizu

Ito

Higuchi

2022

Surgical Neurology International

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“…Rarely, spontaneous hemorrhage of intracranial arachnoid cysts has been described, with few being reported in the spine. [ 3 , 4 , 6 ] Hemorrhagic spinal arachnoid cysts may be warranted by several etiologies and may be associated with poor prognosis [ Table 1 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical spine arachnoid cyst complicated by spontaneous intracystic hemorrhage: Case report and review of the literature

Mastantuoni

Pizzuti

Ricciardi

et al. 2022

Surgical Neurology International

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Background: Spinal intradural extramedullary arachnoid cysts represent about 1–3% of all primary spinal space-occupying lesions often causing spinal cord and/or radicular nerve compression. Spontaneous intralesional hemorrhages are extremely rare and are typically found within intracranial arachnoid cysts. Here, a 55-year-old female presented with a spontaneous hemorrhage into a cervical spine arachnoid cyst warranting surgical intervention (i.e., fenestration/excision/occlusion). Case Description: A 55-year-old female presented with 3 weeks of dull pain in the cervicothoracic region. She subsequently developed paresthesias and progressive lower extremity weakness with (urinary incontinence. The cervical magnetic resonance revealed a right anterolateral intradural extramedullary “cystic” lesion extending from C7 to T2; it contained a heterogeneous signalon T2W sequences, and a fluid-fluid level was documented on the T2-GRE and FLAIR sequences. At surgery, consisting of a laminectomy, two hemorrhagic cystic lesions were identified and removed. Histological findings were consistent with hemorrhagic into an arachnoid cyst. Conclusion: Only rarely hemorrhages develop in intraspinal intradural extramedullary spinal arachnoid cysts.

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“…The presentation of ruptured SACs is mainly characterized by worsening raised ICP symptoms in a previously asymptomatic patient, often with apparently normal neuropsychological development [60,139]. Typically, raised ICP occurs some hours/days or even weeks after the injury (time necessary for the subdural collection formation) [11,13]. Headache and vomiting are almost invariably reported, sometimes in association with papilledema and/or visual deficits (Table 1).…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…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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Arachnoid cyst with spontaneous intracystic hemorrhage and associated chronic subdural hematoma: A case report

Cited by 9 publications

References 14 publications

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Cervical spine arachnoid cyst complicated by spontaneous intracystic hemorrhage: Case report and review of the literature

Ruptured Sylvian arachnoid cysts: an update on a real problem

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