Posttraumatic Intradiploic Leptomeningeal Cyst: A Rare Complication of Head Trauma

Bava, J.; Bansal, Ashank; Patil, Santosh; Kale, Kiran Ashok; Joshi, Anagha

doi:10.1155/2015/395380

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…These cysts can originate in the related bone's inner table and may cause a tear on the dura mater. This situation is ended up with an accumulation of CSF covered by an arachnoid membrane within the diploic space [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Meningitis After a Post-Traumatic Intradiploic Arachnoid Cyst: A Case Report

Yangi¹,

Kaynar²

2023

Cureus

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Intradiploic arachnoid cysts are infrequent but benign lesions of the central nervous system. Etiologically, they can be non-traumatic or post-traumatic in origin. We present an unusual case of a post-traumatic intradiploic arachnoid cyst presented with recurrent meningitis episodes. A 68-year-old female patient was admitted to the emergency department with fever and loss of consciousness, with a history of cranial operation due to a gunshot injury to the left occipital bone 45 years ago. On the patient's initial examination, nuchal rigidity was detected; Kernig's and Brudzinski's signs were positive. A lumbar puncture has been performed, and the patient is diagnosed with meningitis. The patient had been admitted to the emergency department with rhinorrhea after a minor blunt head trauma six years ago. As we understood from the patient's medical records, a couple of millimetric non-specified pneumocephalus areas, located next to the sella turcica, were detected on the cranial non-contrast-enhanced CT scan after the minor blunt trauma to the frontal bone. However, there was no sign of any obvious skull base fracture. The patient was hospitalized for five days and discharged on the sixth day without any complaints. After the discharge, the patient was admitted to other hospitals five times in the last five years with fever and anxiety. On all her admissions, the patient was diagnosed with CSF-culture-negative meningitis and treated with different unknown antibiotics. Magnetic resonance imaging (MRI) showed some irregularities and thinning at the inner table of the left occipital bone; there was an enlargement of the diploic distance of the occipital bone on the left side. MR cisternography showed cerebrospinal fluid (CSF) fistulizing areas just below the thickened and irregular part of the occipital bone. CSF fistula was communicated with the left lateral ventricle. The occipital horn of the left lateral ventricle was enlarged. We performed a surgical repair in order to cover the defective areas of the occipital and mastoid bones. The retromastoid approach was used. Pedunculated muscle flaps to cover the defective bony areas are used and secured with fibrin glue. There is no evidence of recurrence during the one-year follow-up period of the patient. We present this unusual case to emphasize that if post-traumatic intradiploic arachnoid cysts remain untreated, severe complications, such as episodes of recurrent meningitis, may occur. Although a few cases of these cysts are reported in the literature, a case of post-traumatic intradiploic arachnoid cyst presenting with recurrent meningitis has not been reported. In patients with recurrent meningitis, when no prominent etiology is found and if there is a trauma to the related bone in the patient's history, post-traumatic intradiploic arachnoid cyst should be included in the differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Recurrent Meningitis After a Post-Traumatic Intradiploic Arachnoid Cyst: A Case Report

Yangi¹,

Kaynar²

2023

Cureus

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“…Clinical presentation may include a slow-growing swelling associated with headache, giddiness, and occasionally ataxia. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…Clinical presentation may include a slow-growing swelling associated with headache, giddiness, and occasionally ataxia. [9] The most widely agreed-upon hypothesis proposes the herniation of leptomeninges into the intradiploic space through the traumatic rent in the dura mater and inner table. The ball and valve effect due to the child's growing brain and the continuous CSF pulsations act as driving expansile forces facilitating the growth of the intradiploic cyst over the years with resultant thinning of the outer table.…”

Section: Discussionmentioning

confidence: 99%

Large intradiploic growing skull fracture of the posterior fossa with syringomyelia

et al. 2019

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Growing skull fracture (GSF), also known as leptomeningeal cyst, is a rare but significant complication of pediatric head injury. It is mainly seen in infancy and childhood. GSFs of the posterior fossa are uncommon, and intradiploic location in the posterior fossa is extremely rare. Only a few cases of pediatric GSF of the posterior fossa and intradiploic location have been reported in the literature. We report a case of a 15-year-old boy who had large intradiploic GSF of the posterior fossa, associated with cervical syringomyelia. The lesion developed progressively over a period of 5 years following a documented occipital linear fracture. This case of a GSF developing from a known occipital linear fracture demonstrates that a GSF may reach a considerable size, and although uncommon, intradiploic development and occipital localization of a GSF are possible. Syringomyelia associated with posterior fossa GSF is very unusual which makes this case even more unique.

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“…Further, using DWI to exclude dermoid and epidermoid cysts assists with the diagnosis of leptomeningeal cysts [7]. The signal intensity of post-traumatic leptomeningeal cysts is similar to that of the CSF in both T1-weighted and T2weighted images.…”

Section: Case Reportmentioning

confidence: 97%

A Leptomeningeal Cyst in the Frontal Bone as a Complication of Childhood Head Trauma: A Case Report

Osman¹,

Karshe²,

İbrahim³

et al. 2021

jmvi

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Leptomeningeal cysts secondary to trauma represent an extremely rare complication of calvarial fractures experienced during childhood. The early diagnosis and surgical treatment of such cysts can serve to prevent neurological sequelae. A 23-year-old male from a remote region attended the neurosurgery department complaining of headache, insomnia, and slowly progressing swelling over the right frontal region.The patient reported experiencing trauma (cow horn) in the same region of the head some 15 years previously.Non-contrast cranial computed tomography showed a lytic calvarial lesion with a large cystic area in the right frontal bone. Further, brain magnetic resonance imaging (MRI) revealed hyperintensity on the T2-weighted MRI and no enhancement on the T1-weighted post-contrast images. Moreover, there was no restricted diffusion corresponding to the cystic lesion in the frontal region. The dura mater and the bone gap were repaired using titanium mesh. The patient, whose headache and insomnia symptoms had completely disappeared, was discharged five days after the operation.

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Posttraumatic Intradiploic Leptomeningeal Cyst: A Rare Complication of Head Trauma

Cited by 4 publications

References 16 publications

Recurrent Meningitis After a Post-Traumatic Intradiploic Arachnoid Cyst: A Case Report

Recurrent Meningitis After a Post-Traumatic Intradiploic Arachnoid Cyst: A Case Report

Large intradiploic growing skull fracture of the posterior fossa with syringomyelia

A Leptomeningeal Cyst in the Frontal Bone as a Complication of Childhood Head Trauma: A Case Report

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