Bilateral Temporal Extradural Hematoma on Top of Bilateral Temporal Arachnoid Cyst: First Case Report and Extensive Literature Review

Abbas, Munzir; Khairy, Sami; AlWohaibi, Mohammad; Aloraidi, Ahmed; AlQurashi, Waleed Waslallah

doi:10.1016/j.wneu.2018.04.040

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…The MRI signal of an arachnoid cyst in the sellar region is consistent with that of cerebrospinal fluid. Arachnoid cysts are located outside the pituitary, which differentiates them from RCCs (22). Pituitary abscesses are rare and on MRI, enhancement effects are observed in the pituitary stalk, the dura mater around the pituitary and the sphenoid sinus mucosa (23).…”

Section: Discussionmentioning

confidence: 99%

MRI and pathological features of Rathke cleft cysts in the sellar region

Wang

Nie

et al. 2019

Exp Ther Med

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The aim of the present study was to investigate the MRI and pathological features of Rathke cleft cysts (RCC) in the sellar region. A total of 45 RCC cases were retrospectively analyzed. RCC size, location, intracyst nodules and general signals, as well as the posterior pituitary bright spot (PPBS) were analyzed using MRI-T1 weighted images (T1WI) and T2WI. The relationship between the presence of PPBS and histopathological features was additionally evaluated. On T1WI, there were 18 cases of isointense signal, 16 cases of hyperintense signal, 9 cases of hypointense signal, 1 case of heterogeneous signal and 1 case with a stratification effect, with isointense signal in the upper part and hyperintense signal in the lower part. On T2WI, there were 5 cases of isointense signal, 27 cases of hyperintense signal, 11 cases of hypointense signal and 1 case of the stratification effect. There were 10 cases of PPBS+ and 35 cases of PPBS-. There were no significant differences in the age, sex, cyst location and size between PPBS+ and PPBS- cases. However, PPBS+ cases had significantly lower inflammation than PPBS- cases. A total of 20 cases of intracystic nodules were identified on MRI scans, most of which exhibited T2 -hypointense signals. The shape of RCC nodules varied and there were 17 cases where the nodules were non-adherent to the cyst wall. The MRI signals of RCCs varied and most nodules were floating within cysts. Intracystic nodules are characteristic features of RCCs when observed by MRI and thus are of high diagnostic value. Most patients with RCC were also PPBS-, which may be associated with an increased inflammatory response.

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Section: Discussionmentioning

confidence: 99%

MRI and pathological features of Rathke cleft cysts in the sellar region

Wang

Nie

et al. 2019

Exp Ther Med

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“…Some authors propounded the stripping of the dura from the inner skull table as the cause of the tear in the middle meningeal vein to explain the low-pressure extravasation usually occurring in such instances [ 29 ]. Abbas et al, finally, hypothesized that the thinned temporal bone surrounding the cyst, being more fragile and prone to be fractured, could favor the bleeding from the meningeal vessels and the detachment of the dura in case of moderate head injury, thus leading to an extradural hematoma [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Seizures are occasionally reported, affecting at most 6% of cases [100]. A transient loss of consciousness immediately after the head injury is not rare [21,23,29,37,52]. In 27 cases, the brain concussion and the rupture of the SACs were complicated by coma [88,117].…”

Section: Clinical Aspectsmentioning

confidence: 99%

Ruptured Sylvian arachnoid cysts: an update on a real problem

et al. 2022

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Purpose Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition. Methods A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations. Results A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated. Conclusions The “spontaneous” or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.

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“…Görgülü A et al, reported a patient (GCS = 15) of bifrontal extradural hematoma with a sickness of 15 mm, CT scan showed reabsorption of the hematoma after 17 days of conservative management [ 2 ]. Early surgical evacuation of bilateral extradural hematoma revealed favorable postoperative outcomes and GOS of 5 [ 2 , 12 , 13 ].…”

Section: Clinical Discussionmentioning

confidence: 99%