Head Injury without Head Blow? A Rare Case of Subdural Hematoma Associated with Minute Arachnoid Cyst in a Teenage Skater

Szczygielski, Jacek; München, Dorothea; Ketter, Ralf; Ràkàsz, Lukas; Schulz‐Schaeffer, Walter; Oertel, Joachim

doi:10.1055/s-0040-1721021

Cited by 3 publications

(1 citation statement)

References 39 publications

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“…From the literature, it may be postulated that nontraumatic CSDHs in young patients could be associated with spontaneous AC-related hemorrhage. [ 1 , 2 , 7 , 8 , 10 , 11 , 14 , 15 ] The etiologies of hemorrhage in subdural and/or intracystic spaces include: (1) rupture of bridging veins by tearing of the outer wall of the AC;[ 7 , 14 ] (2) rupture of unsupported blood vessels around the cyst wall;[ 7 , 8 ] and (3) rupture of leptomeningeal vessels at the base of the cyst. [ 7 , 8 ] To the best of our knowledge, there are no reported cases of nontraumatic SDH followed by AC hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Shimizu

Ito

Higuchi

2022

Surgical Neurology International

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Background: Diagnosing the cause of headaches can be challenging. Even if intracranial lesions are found in a patient, careful assessment is essential for diagnosis, and treatment strategies will differ for each etiology. Case Description: A 16-year-old boy presented with sudden-onset headache which had lasted for 2 days. His headache was aggravated in the orthostatic position. The patient denied recent head trauma. He had been diagnosed with an arachnoid cyst (AC) in his right middle cranial fossa. Computed tomography (CT) revealed bilateral subdural effusions and slit-like lateral ventricles with no significant changes to the AC. After intravenous hydration followed by 2 days bed rest, his symptoms abated. He was diagnosed as having suffered spontaneous cerebrospinal fluid (CSF) hypovolemia. One month later, the patient experienced recurrent gradual onset headache and vomiting. CT revealed chronic right side subdural hematoma (SDH) with intracystic hemorrhage, which resulted in the elevation of intracranial pressure. An urgent hematoma evacuation was performed. He became symptom-free immediately after surgery. Postoperative follow-up CT showed no change in the AC and no recurrence of SDH. The lateral ventricles and subdural space were normal in size. Conclusion: We report a case presenting multiple types of secondary headaches, which were caused by intracranial hypotension or hypertension, with different etiologies. These were spontaneous CSF hypovolemia, nontraumatic intracystic hemorrhage form of AC, and nontraumatic chronic SDH. Although lesions seen at the time of initial diagnosis did not need surgical treatment, careful observation and repetitive imaging assessments might be useful for discovering unsuspected additional etiologies requiring surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Shimizu

Ito

Higuchi

2022

Surgical Neurology International

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Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Wang

Liu

et al. 2023

World Neurosurgery

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Chronic subdural hematoma: What precisely are we treating?

Qiao,

Alkarawi,

Provasek

et al. 2024

Interv Neuroradiol

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Subdural hematoma (SDH) refers to the collection of blood between the dura matter and the arachnoid membrane. Advancements in imaging technology have enabled the categorization of SDH based on specific imaging characteristics, causative factors, and the onset of symptoms. Given that the prognosis of SDHs varies significantly and is contingent upon the size and chronicity of the hemorrhage, a comprehensive understanding of its subtypes may carry crucial treatment implications. For example, an acute SDH classically results from severe traumatic brain injury and appears as a homogenous, crescent-shaped hyperdense extra-axial collection. If not treated, over the course of 1–3 weeks, this hematoma will evolve into a sub-acute phenotype as a consequence of subdural effusion and demonstrate mixed-density hemorrhage on imaging. Chronic SDH (cSDH) becomes the end result of an untreated SDH, with neo-membranization and neo-angiogenesis from branches of the middle meningeal artery driving a mass-like growth pattern. This review article aims to elucidate the complex anatomical features of the end-stage cSDH, with a particular focus on reconceptualization of this entity based on its mass-like growth patterns, and how this is driving a shift towards endovascular treatment.

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Head Injury without Head Blow? A Rare Case of Subdural Hematoma Associated with Minute Arachnoid Cyst in a Teenage Skater

Cited by 3 publications

References 39 publications

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report

Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Chronic subdural hematoma: What precisely are we treating?

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