Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis

Abstract

Neurosurg Focus 40 (4):E9, 2016S port-related concussion (SRC) has emerged as a public health problem, affecting athletes of all ages and participation levels. 11,35,43 While SRC by definition includes normal imaging results, a minority of sportrelated head injuries result in structural brain injury. 3,18,19,84,85 These cases are often neurosurgical emergencies and can result in permanent neurological deficit and/or death. Recent literature has postulated that athletes with arachnoid cysts (ACs) demonstrate a higher rate of structural brain injury after trauma, specifically subdural hematoma (SDH) or hygroma. 37,44,79 ACs are congenital lesions bordered by an arachnoid AbbreviAtioNs AC = arachnoid cyst; ICP = intracranial pressure; IPH = intraparenchymal hemorrhage; IQR = interquartile range; PCS = postconcussion syndrome; SDH = subdural hematoma; SRC = sport-related concussion. objeCtive Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis. MethoDs Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non-sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed. resUlts After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4-75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received a cystoperitoneal shunt. Four cases reported medical management only without any surgical intervention. No significant predictors were found for neurological deficit or open cr...

Concomitant chronic subdural hematomas and arachnoid cysts in young adults

“…Various previous researches have conferred the risk of cSDH related with ACs. 3,4,7,8,12,13 The exact mechanism is still unclear. However, theories suggest that 1) veins within the wall could be hurt because of decreased compliance 2) veins without structural support of cyst wall are vulnerable 3) a slit-valve mechanism is formed, lead to increased pressure within the AC and vein rupture.…”

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

“…14,15 The problem of AC as a cause of subdural bleeding is by no means not new, as noticed by Robinson as early as 1971. 6 Since then, several publications addressed the issue of AC coincidence with subdural hematoma in patients of exceptionally young age 6,16-20 (including case series analyses and exhaustive reviews 10, 21,22 ). Also, causal relationship between minor sports-related trauma and subsequent treatment of chronic subdural bleeding in AC bearing subjects has been previously suggested.…”

“…Indeed, in the majority of case reports in which AC bleeds spontaneously or after minor trauma, some large, middle fossa cysts were described. 10, 21,22 Moreover, the size of the cyst has been identified as a risk factor for hematoma by Cress et al, 29 although Wester and Helland found that the temporal location rather than the size of the AC itself defines the risk of CSDH. 28 Both observations make our case even more unusual, since a small-size frontal convexity cyst can hardly be expected to bleed spontaneously.…”

Concomitant chronic subdural hematomas and arachnoid cysts in young adults

“…However, theories suggest that 1) veins within the wall could be hurt because of decreased compliance 2) veins without structural support of cyst wall are vulnerable 3) a slit-valve mechanism is formed, lead to increased pressure within the AC and vein rupture. 9,[12][13][14] The compliance of the cyst is less than the normal brain.…”