Intracranial arachnoid cyst associated with traumatic intracystic hemorrhage and subdural haematoma

Abstract

Background: Brain arachnoid cysts are fluid collections of developmental origin. They are commonly detected incidentally in patients imaged for unrelated symptoms.

Case description: A 15-year-old healthy boy with a recent history of head trauma experienced headache that gradually worsened over the course of 10 days. He underwent CT and MRI brain scans which revealed the presence of subdural haematoma caused by the rupture of a middle cranial fossa arachnoid cyst. This was accompanied by intracystic haemorrhage. The subdural haematoma was removed, while communication of the cyst with the basal cisterns was also performed. The postoperative course of the patient was uneventful.

Conclusions: The annual haemorrhage risk for the patients with middle cranial fossa cysts remains very low. However, when haemorrhage occurs, in most occasions it can be effectively managed only with haematoma evacuation.

Keywords: intracranial arachnoid cyst; intracystic bleeding; subdural haematoma; treatment.

Figure 1.. Computed Tomography (CT) scan showing the presence of subdural haematoma in the right frontotemporal region (arrows)

Figure 2.. Sagittal T1 post contrast Magnetic Resonance Imaging (MRI) scan (a) and T2 sequence MRI scan clearly demonstrating arachnoid cyst, subdural haematoma and intracystic hemorrhage (arrows)

Figure 3.. Postoperative axial CT scan with contrast enhancement at 1-year. The arachnoid cyst in the right temporal lobe is present with no evidence of intracranial hemorrhage and mass effect (arrow)