Intracranial aneurysm and arachnoid cyst: a rare association between two cerebral malformations

Abstract

Intracranial aneurysms and arachnoid cysts are cerebral disorders of a high prevalence. However, association between both malformations is a rare finding. The aim was to analyse this association with regard to the different clinical presentations according to the haemorrhage types, as well as the pathogenesis of this association. We searched the English language literature in MEDLINE database in order to include all manuscripts in which this association was found. A new case of a 55-year-old man with a large posterior communicating artery aneurysm and a middle cranial fossa arachnoid cyst presenting with headache and seizure was added to review of the literature and presented as an illustrative case. Nine cases were found. Six were male and three were female. The mean age was 42 years (range 29-66 years). All but one arachnoid cysts were located at middle cranial fossa, aneurysms arose from middle cerebral artery in three cases, internal carotid artery bifurcation in two cases, posterior communicating segment of carotid artery in two cases, anterior communicating artery in one case and azygos pericallosal artery in one case. Clinical presentation was related to aneurysmal rupture in six cases (subarachnoid haemorrhage in four, subdural haematoma in one and intracystic haematoma in two) and related to arachnoid cysts in three cases, where the most common symptoms were seizures and headache. Association between intracranial aneurysms and arachnoid cysts is a rare finding that can present with signs and symptoms related to aneurysm rupture, or with mass effect and seizures related to the cyst. The aneurysmal haemorrhage may be atypical, since it can be into the subarachnoid space, into the arachnoid cyst, or into the subdural space.

Intracranial aneurysm and arachnoid cyst: just a coincidence? A case report

“…In most of these cases, intracranial hemorrhage was the first manifestation. 5 There has also been one report of multiple aneurysms associated with arachnoid cysts, 2 which evolved with rupture of the intracystic aneurysm, without typical subarachnoid hemorrhage. 1 All of these possibilities should be borne in mind during neuroimaging evaluations on patients with arachnoid cysts without symptoms and on those who present with intracranial hemorrhage.…”

“…2 In the present report, this diagnosis was an incidental finding. de Oliveira et al 5 found associations between aneurysms and arachnoid cysts through a review of the literature in which only 10 cases were reported. In most of these cases, intracranial hemorrhage was the first manifestation.…”

“…5 These symptoms occur when there is increased pressure on the neighboring structures. 5 Neurological signs and symptoms may originate from bleeding inside the cyst.…”

“…1 Even mild TBI can cause subdural hematomas or intracystic hemorrhage. 1,5 Intracystic hemorrhage due to ruptured brain aneurysm is an extremely rare condition, 1 with few cases reported in the literature.…”

“…3 Therefore, although they are common lesions that are often associated with collagen diseases such as Marfan syndrome and polycystic renal disease, 3 an association between an arachnoid cyst and brain aneurysm in the same patient is extremely rare. 4,5 The aim of this paper was to report a case of a patient with a diagnosis of an arachnoid cyst and a non-ruptured intracystic brain aneurysm. The literature on this rare condition was also reviewed.…”