Spontaneous acute subdural hematoma contralateral to an arachnoid cyst

Abstract

-Arachnoid cysts (AC) are extra-cerebral cerebrospinal fluid collections of unknown origin. They correspond to 1% of all intracranial nontraumatic space-occupying lesions and appear more frequently in the middle fossa (50%). More than 25% of these cysts are incidental findings and the majority of patients are asymptomatic. Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. AC rupture and bleeding are rare, usually occurring in young adults and associated with trauma. The risk of hemorrhage does not exceed 0.04% / year. We describe the case of a ten-year-old boy who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma, contralateral to an AC of the middle fossa. Three factors were significant in this case: signs and symptoms occurred spontaneously; the presence of an acute subdural hematoma exclusively contralateral to the AC; successful outcome of the conservative treatment.KEY WORDS: arachnoid cyst, subdural hematoma, pediatric neurosurgery. Hematoma subdural agudo espontâneo contralateral a cisto aracnóideoRESUMO -Os cistos aracnóideos (CA) são coleções liquóricas extra-cerebrais e intra-aracnóideas de origem desconhecida. Correspondem a 1% de todas as lesões expansivas intracranianas não traumáticas e têm ní-tido predomínio na fossa média (50%). Até 25% destes cistos são achados incidentais sendo que a maioria dos pacientes é assintomática. Crises epilépticas, sinais de hipertensão intracraniana, déficits neurológicos focais, macrocrania, atraso no desenvolvimento e abaulamento da calota craniana são os principais sinais e sintomas da lesão. A ruptura dos CA, assim como seu sangramento, são situações raras, geralmente associadas a traumas e acometem adultos jovens. O risco de hemorragia em pacientes com CA não excede 0,04% ao ano. É descrito caso de paciente de dez anos de idade que subitamente apresentou sinais de hipertensão intracraniana secundários a hematoma subdural agudo espontâneo, contralateral a volumoso CA de fossa média. Três fatores foram de relevância neste paciente: a ocorrência de sinais e sintomas espontaneamente, especialmente em um menino; presença de hematoma subdural agudo exclusivamente contralateral ao CA; e a boa evolução com o tratamento conservador. PALAVRAS-CHAVE: cisto aracnóideo, hematoma subdural, neurocirurgia pediátrica.

Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature

“…The main causes involve aneurysmal rupture,[367891011121314151617181920212223242526272829303132333435363738394041424344] rupture of perisylvian cortical arteries[4546474849505152535455] and tumors and neoplastic diseases. [565758596061626364656667] Some other rare causes include moyamoya disease,[6869] arachnoid cyst,[70] dural cavernous angioma,[71] dural arteriovenous fistula,[72] myelodysplastic/myeloproliferative disorder[73] and polycythemia vera. [74] The most common cause of spontaneous ASDH was aneurysmal rupture (135 cases about 75.8% of cases).…”

“…[5657585960616263646566676869707172] Intracranial and metastatic extracranial tumors with involvement of dura matter can cause ASDH. These cases include metastatic seminoma,[56] meningioma,[5758] metastatic lung cancer,[5960] anaplastic astrocytoma of brain,[61] choriocarcinoma,[62] metastatic adenocarcinoma of prostate,[63] chronic myeloblastic leukemia,[64] malignant pleural mesothelioma,[65] metastatic dural carcinomatosis[66] and paranasal sinus cancer.…”

Arachnoid Cyst with a Non-traumatic Acute Subdural Hematoma in an Eleven-year-old Patient

“…The risk of bleeding does not exceed 0.04% per annum. 2 When bleeding does occur, most cases are associated with head injury. In this case, there was no report of injury, which makes this case even rarer.…”

“…7 Moreover, signs of intracranial hypertension, seizures, macrocrania, and delayed development in the last thirty days must be considered warning signs of cyst rupture. 2 Based on the literature reviewed, treatment is essentially surgical, although largely contingent on the patients symptoms. Surgery is indicated when there are important symptoms and/or complications of the disease.…”

“…Risk of hemorrhage does not exceed 0.04%/ year. 2 We report a case of an eleven-year-old boy with a previously asymptomatic arachnoid cyst that suddenly presented a non-traumatic acute subdural hematoma and intra-cystic hemorrhage.…”