Spontaneous Acute Subdural Hematoma Associated with Arachnoid Cyst and Intra-cystic Hemorrhage

Abstract

Arachnoid cysts (ACs) are congenital, extra-axial lesions containing fluid similar to the composition of cerebrospinal fluid. Usually found incidentally, these lesions are observed with serial imaging to document their growth patterns and stability, and are then followed conservatively until clinical symptoms develop. Surgical options for symptomatic arachnoid cysts include cyst aspiration, cyst evacuation with fenestration into the subarachnoid space, and shunt procedures including cysto-peritoneal and cysto-ventricular shunts. Intra-cystic hemorrhage and subdural hematoma are rare and more emergent sequelae of ACs that may require an emergent craniotomy. This case report further documents a rare cause of spontaneous subdural hematoma, as well as serves as a pivot point for further discussion into whether continued neuroimaging surveillance in patients with ACs would prove to be beneficial.

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

“…[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. 1,2,4,6,8,11 Spontaneous cyst ruptures, as seen in this patient, are exceedingly rare.…”

Spontaneous chronic subdural hematoma associated with arachnoid cyst in a child: A case report and critical review of the literature

“…[44] Reviewing the literature, we found 57 reports published during 1976-2019, with a total number of 183 cases of CSDH in association with AC with age ranging between 3 years and 58 years [Table 1]. [1,7,8,[11][12][13][14][15][16][17][20][21][22]25,26,29,30,33,34,36,39,40,42,45,46,48,[54][55][56][57][58][59][60]63,64,[66][67][68][69][70][71] ere were 31 single case reports, 12 publications reporting on 2-3 patients, and 14 case series reporting on 5-16 patients. ere are some data to support that the coexistence of CSDH and AC is not incidental, and two pathogenic mechanisms were proposed to explain such association.…”

Non-Operative Management of a Pediatric Patient With Bilateral Subdural Hematomas in the Setting of Ruptured Arachnoid Cyst

“…It is suspected that veins between the dura and the AC contribute to the hemorrhage [ 16 - 18 ]. Management of AC associated with SDH has been overwhelmingly operative as reported in the literature [ 3 , 9 , 10 , 16 , 19 ]. Treatment options include craniotomy for early hemorrhages or burr holes for more chronic hemorrhages [ 12 ].…”

“…Symptoms are thought to develop secondary to enlargement of the AC, with younger age at presentation, larger size of the cyst, and presence of cyst-associated symptoms being predictors for surgical management in pediatric cases [ 7 , 8 ]. The natural history in pediatric AC is overwhelmingly benign but can be associated with headache, hydrocephalus, seizures, cognitive sequela, and rupture into the subdural space [ 7 , 9 ]. Repeat imaging in six months to one year to ensure stability is frequently considered appropriate, although no standardized surveillance protocol exists [ 9 ].…”

“…The natural history in pediatric AC is overwhelmingly benign but can be associated with headache, hydrocephalus, seizures, cognitive sequela, and rupture into the subdural space [ 7 , 9 ]. Repeat imaging in six months to one year to ensure stability is frequently considered appropriate, although no standardized surveillance protocol exists [ 9 ].…”