Spontaneous Subdural Haematoma Developing Secondary to Arachnoid Cyst Rupture

Abstract

A 17-year-old boy had been admitted to the outpatient clinic of eye diseases, with the complaints of intensifying headache and double vision for the previous 10 days. Papilloedema had been detected in his fundoscopic examination and the patient had been referred to the Department of Neurosurgery, after eliminating possible ophthalmological pathologies. His physical examination was unremarkable. The neurological examination revealed only painless restriction of his eye movement in left lateral gaze. He had no history of trauma. Cranial CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) revealed a left temporal arachnoid cyst and a left frontoparietal subdural haematoma 2.5 cm in thickness causing an 11mm midline shift [Table/ Fig-1a&b]. Subdural haematoma was evacuated via a left fronto-parietal craniotomy. No intervention was performed for the arachnoid cyst since the haematoma was not intracystic. Post-operative CT scan revealed that the subdural haematoma had been evacuated successfully . No perioperative or post-operative complication was encountered. The patient was discharged from hospital on the 5 th day of operation, with no neurological deficit. One-year follow-up MRI of the patient revealed no recurrence of haematoma and no significant change in pre-existing arachnoid cyst [Table/ Fig-3 ABSTRACTArachnoid cysts are congenital, benign, non-neoplastic, extra-axial intra-arachnoidal lesions. Arachnoid cysts rarely become symptomatic, with bleeding. Intracranial haemorrhage as a complication of arachnoid cyst is a very rare condition. It is well-known that mid-cranial fossa cysts might cause intracerebral haemorrhage or subdural haematoma secondary to traumas. However, the occurrence of spontaneous subdural haematoma secondary to arachnoid cysts, developing without any trauma, is even rarer. A 17-year-old boy presenting with diplopia and headache, with no history of trauma, was diagnosed with left temporal lobe arachnoid cyst and left fronto-parietal subdural haematoma. He was operated on, solely for his haematoma, with no intervention performed for the arachnoid cyst. Authors suggest that it is sufficient to perform an operation for the haematoma only -without arachnoid cyst resection-if there is no clinical presentation specific to the arachnoid cyst itself.

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

“…Arachnoid cysts (ACs) are congenital, non-neoplastic, extra-axial, intra-arachnoid lesions that contain a fluid similar in composition to cerebrospinal fluid [ 1 - 3 ]. They constitute approximately 1% of all intracranial space-occupying lesions [ 1 , 3 - 5 ].…”

“…Arachnoid cysts (ACs) are congenital, non-neoplastic, extra-axial, intra-arachnoid lesions that contain a fluid similar in composition to cerebrospinal fluid [ 1 - 3 ]. They constitute approximately 1% of all intracranial space-occupying lesions [ 1 , 3 - 5 ]. Most ACs are indolent lesions that remain asymptomatic until they are found incidentally after neuroimaging for an unrelated problem [ 4 , 6 - 7 ]; however, ACs can be the source of headaches, increased head circumference, and developmental delay in pediatric patients; rarely, they can cause weakness, seizures, or psychiatric alterations [ 1 ].…”

“…Arachnoid cysts (ACs) are congenital, non-neoplastic, extra-axial, intra-arachnoid cystic lesions that contain fluid similar to the composition of cerebrospinal fluid [ 1 - 3 ]. Most of these lesions are found incidentally while undergoing neuroimaging for other unrelated problems; however, ACs are known to be a cause of headaches, increasing head circumference, and developmental delay in pediatric patients; rarely, patients may develop symptoms of weakness, seizures, and endocrinopathies, depending on the AC's location [ 1 ].…”

“…The feared complication associated with ACs is the possibility of rapid expansion secondary to the intra-cystic hemorrhage or tearing of the subdural bridging veins with subsequent formation of a subdural hematoma (SDH), both of which can be life-threatening to the patient. The SDH can be spontaneous as the cyst continues to grow or, more commonly, can be the result of physical exertion or traumatic insult [ 1 - 3 ]. In this article, we present a case of an atraumatic spontaneous acute subdural hematoma associated with a previously deemed stable arachnoid cyst.…”

An incidental finding on computed tomography scan

“…The annual risk for haemorrhage in patients with a middle cranial fossa cyst is below 0.1% 3. Middle cranial fossa cysts can rupture as a result of trauma or rarely spontaneously, and cause intracerebral haemorrhage or subdural haematoma 45. In these cases, the ruptured cysts might be monitored or fenestrated surgically if they cause raised intracranial pressure.…”