Supratentorial arachnoid cyst mimicking a Ménière’s disease attack

Abstract

Arachnoid cysts (AC) often present with symptoms depending on their anatomical location within the skull; while supratentorial cysts grow causing relatively few symptoms, infratentorial ones may impair liquor circulation at the level of the fourth ventricle, giving rise to intracranial hypertension, or may stretch the complex nerve network in the cerebello-pontine angle. We report the singular clinical history of a 54-year-old male, who suddenly began to feel dizzy while sitting at his workplace, complaining of left tinnitus and aural fullness, in a classic clinical picture of Ménière's disease. The anomalous findings at otoneurological examination (markedly the left deviation at the Fukuda test) made a magnetic resonance image (MRI) scan mandatory and a huge AC was found in the left fronto-parietal lobe. The mass provoked an evident clockwise rotation of the brainstem that we suppose to be the cause of acoustico-facial bundle stretching explaining the vestibular symptomatology.

Invasive Cerebrospinal Fluid Cysts and Cephaloceles of the Petrous Apex

“…Arachnoid cysts are most commonly found in the middle fossa at the sylvian fissure and represent 1% of all intracranial spaceYoccupying lesions (11). The CPA is the second most common location for arachnoid cysts (7,9). Temporal bone involvement is rare (1,2,6,9Y11,16Y18).…”

“…Sixty percent to 70% of the patients with arachnoid cysts become symptomatic in childhood, whereas the remainder of these patients present between the third and fifth decade with a slight male preponderance (7). Arachnoid cysts often present with vague and nonspecific symptoms that often result in a delay in diagnosis (7).…”

“…Arachnoid cysts often present with vague and nonspecific symptoms that often result in a delay in diagnosis (7). Symptoms may include headaches, nausea, visual loss, seizures, ataxia, or dizziness and often do not correlate with the size of the arachnoid cyst (9).…”

“…Symptoms may include headaches, nausea, visual loss, seizures, ataxia, or dizziness and often do not correlate with the size of the arachnoid cyst (9). Location is often relevant because CPA cysts commonly produce vestibular abnormalities; cysts that obstruct the flow of CSF may present with signs and symptoms of increased intracranial pressure (ICP) (7,9). Temporal bone arachnoid cysts have been reported to present with symptoms of facial pain, paresthesia, CSF otorrhea, or meningitis (2).…”

“…These lesions are most commonly located in the middle cranial fossa (2,6,7). They are often asymptomatic, but they may present with a variety of signs and symptoms depending on their location.…”