Arachnoid cysts with spontaneous intracystic hemorrhage and associated subdural hematoma: Report of management and follow-up of 2 cases

Abstract

Arachnoid cysts are one of the most frequently encountered intracranial space-occupying lesions in daily neurosurgery and neuroradiology practice. Majority of arachnoid cysts, particularly those of smaller sizes, have a benign uneventful lifetime course. Certain symptoms may indicate serious complications related to underlying arachnoid cysts. Hemorrhage is one of the most fearsome complications of arachnoid cysts and almost all reported cases in the literature have undergone surgical correction. In this study, we aimed to present clinical and radiologic follow-up findings in two adult cases of intracranial arachnoid cyst with spontaneous intracystic hemorrhage and associated subdural hematoma, one of which was successfully treated conservatively. In addition, we broadly summarized and discussed pertinent studies in the English literature.

Subdural hygroma after spontaneous rupture of an arachnoid cyst in a pediatric patient: A case report

“…Arachnoid cysts are composed of an accumulation of CSF in between the layers of the arachnoid membrane [3 , 4] . Due to the increase in usage of cross-sectional diagnostic imaging in recent years, most arachnoid cysts are found incidentally [1 , 3 , 6] . Patients are often asymptomatic with the cyst remaining stable [2 , 7] .…”

“…They are often left-sided in the middle cranial fossa and affect males more frequently than females [1 , 2] . Development of a subdural hematoma, intracystic hemorrhage, or subdural hygroma is a rare complication that can sometimes occur following head trauma [1 , 3 , 4] . Even rarer, a subdural hygroma can occur spontaneously with no history of trauma to the head [5] .…”

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

“…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 ]. Complications associated with ACs concern their continued growth, which can exacerbate headaches, create a focal neurological deficit or, particularly with suprasellar and quadrigeminal ACs, also result in obstructive hydrocephalus or brainstem compression, which can be life-threatening [ 1 , 8 ].…”

“…The acute, atraumatic SDH our patient developed appears to represent an even more rare sequalae for ACs. Spontaneous intra-cystic hemorrhage and ASDH has been reported by Adin et al in two patients at their institution [ 4 ]. One patient complained of severe headaches and a burning sensation in the left side of his head and face, and the other patient had a one-week history of progressive nausea, vomiting, and headaches.…”

“…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 ]. Fortunately, most ACs remain stable over the patient’s lifetime, while complete disappearance has also been reported [ 4 ]. 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.…”