Arachnoid Cyst Is a Risk Factor for Chronic Subdural Hematoma in Juveniles: Twelve Cases of Chronic Subdural Hematoma Associated with Arachnoid Cyst

Abstract

Chronic subdural hematoma (CSDH) tends to occur in elderly patients with a history of mild head injury at a few months prior to the onset of symptoms. Intracranial arachnoid cyst is believed to be congenital and sometimes becomes symptomatic in pediatric patients. These two distinct clinical entities sporadically occur in the same young patient. Twelve of 541 cases of CSDH surgically treated in our institution had associated arachnoid cyst. The clinical and radiological characteristics of the cases of CSDH associated with arachnoid cyst were retrospectively analyzed and compared with those of CSDH without arachnoid cyst. Arachnoid cysts were located in the middle fossa (eight cases), convexity (two cases), and posterior fossa (two cases). Three cysts were less than 20 mm in diameter. The 12 patients with CSDH and arachnoid cyst (mean age 27.8 +/- 19.7 years) were significantly younger (p < 0.001) than the patients with CSDH without arachnoid cyst (69.5 +/- 13.7 years). Five of the 12 patients were pediatric cases (< 15 years old). The clinical symptoms were also significantly different. The most frequent symptom was headache followed by vomiting in the patients with arachnoid cyst, while gait disturbance and hemiparesis predominated in patients without arachnoid cyst. Hematoma evacuation through burr holes improved the symptoms in all patients with arachnoid cyst. We conclude that even a small arachnoid cyst can be a risk factor for CSDH after mild head injury in young patients and symptoms of increased intracranial pressure are common. Hematoma evacuation is adequate at first operation. If the preoperative symptoms persist, additional arachnoid cyst surgery should be considered. The present results also suggest that CSDH formation may be preceded by subdural hygroma caused by the rupture of arachnoid cyst.

Autosomal dominant polycystic disease with associated arachnoid cysts and subdural cystic hygroma requiring shunting

“…However, arachnoid cysts can be associated with the development of symptomatic subdural hygromas and subdural hematomas. [4][5][6] These subdural abnormalities are thought to occur due to rupture of an arachnoid cyst and in the case of subdural hematoma hemorrhage into the subdural space, associated with trauma. The reported risk of subdural hematoma in patients with arachnoid cyst is 8 to 17%.…”

“…The reported risk of subdural hematoma in patients with arachnoid cyst is 8 to 17%. 6 Hence, it is currently not recommended to surgically treat arachnoid cysts to prevent cystic hygroma and subdural hematoma. It is, however, recommended that patients with arachnoid cyst try to avoid head trauma.…”

Spontaneous acute subdural hematoma contralateral to an arachnoid cyst

“…Both had favorable outcomes 4 . When emergency surgery is necessary for patients with AC and subdural hematomas the direct approach to the AC is usually not necessary, because the cyst frequently decreases or disappears after the evacuation of the hematoma or hygroma 4,13,14 . This is the expected outcome for intracystic or ipsilateral hematomas, which are different of the contralateral hematoma of our patient.…”

Incidental Findings on Brain and Spine Imaging in Children

“…Hemorrhage may occasionally occur into an arachnoid cyst after trauma. [97][98][99][100] Because this is also a very rare event, prophylaxis against future hemorrhage risk should not be used to justify surgical treatment in an asymptomatic child. Furthermore, hemorrhages associated with arachnoid cysts are associated with generally good outcomes, even when surgical evacuation of the hemorrhage is deemed necessary.…”