Ruptured temporal lobe arachnoid cyst presenting with severe back pain

Abstract

<jats:p>Arachnoid cyst is a common congenital anomaly in the pediatric population. The cysts are often asymptomatic, but they can cause headache and other symptoms. Occasionally a cyst may rupture after head trauma producing a subdural hematoma. The authors present the case of an 11-year-old boy who presented after a week of progressive and severe back pain radiating to the back of his thighs. Imaging revealed a spinal subdural blood collection at the L4–S1 level. This finding prompted further cephalad imaging of the spine and the brain, which revealed a sylvian fissure arachnoid cyst with intracystic hemorrhage and frontoparietal subdural hematoma. The child did not have headache at this time, although he had experienced chronic headaches since the age of 4 years. He was treated with a course of oral steroids, which immediately relieved his back and leg pain. Subsequent imaging showed resolution of the cranial and spinal subdural blood collections and diminished size of the arachnoid cyst. No surgical treatment was necessary.</jats:p>

An unusual cause of back pain in a child: spinal subdural haematoma secondary to intracranial arachnoid cyst haemorrhage

“…Fewer than 30 cases of spontaneous intracystic haemorrhage have been reported in the literature, at least six of which occurred in patients under the age of 18 (7)(8)(9)(10)(11). Patients with these complications would be expected to present with headache, vomiting or neck stiffness (11,12). However, our patient did not describe any of these symptoms.…”

“…In a similar case described by Lohani et al, the patient was also managed nonoperatively, although oral steroids were given due to clinical evidence of radiculopathy (11). Spontaneous resolution of the intracranial and spinal haematomas was reported in that case and has also been described elsewhere in the literature (11)(12)(13). If there is mass effect or neurological deficit, several surgical options are available.…”

“…Intracystic and subdural haemorrhages are rare complications of arachnoid cysts, which can arise spontaneously or following head trauma (7). Fewer than 30 cases of spontaneous intracystic haemorrhage have been reported in the literature, at least six of which occurred in patients under the age of 18 (7)(8)(9)(10)(11). Patients with these complications would be expected to present with headache, vomiting or neck stiffness (11,12).…”

Posttraumatic Acute Spinal Subdural Hematoma of the Spine

“…8,15,[23][24][25][26][27] However, in selected cases with smaller size of the clot and no mass effect, a conservative management has shown favorable outcome. 15,28 Conclusion ASSH is an uncommon complication of the spinal injury. The diagnosis of traumatic ASSH needs high index of suspicion, and in symptomatic cases, an urgent evacuation of the clot and decompression of the neural structures result in favorable outcome.…”