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Case Reports
. 2014 Nov 18:79:422-5.
doi: 10.12659/PJR.890992. eCollection 2014.

Suprasellar Arachnoid Cyst with Spontaneous Intracystic Hemorrhage: A Rare Complication - Role of MR and Illustration of a Case

Richa Arora  1 , Aneel Kumar Puligopu  1 , Megha S Uppin  1 , Aniruddh Kumar Purohit  1
Affiliations
Case Reports

Suprasellar Arachnoid Cyst with Spontaneous Intracystic Hemorrhage: A Rare Complication - Role of MR and Illustration of a Case

Richa Arora et al. Pol J Radiol. .

Abstract

Background: Arachnoid cysts are congenital or developmental intra-arachnoidal CSF-filled lesions, which develop probably as a result of splitting or duplication of the arachnoid membrane. Most of them are asymptomatic and are detected as incidental findings on Computed Tomography or Magnetic Resonance Imaging of the head carried out for other reasons. Although complications such as intracystic, subdural, and extradural hematomas are well known after a trauma, spontaneous hemorrhage in an arachnoid cyst is a rare and serious complication with atypical imaging features on cross-sectional imaging and only less than ten cases are documented in the literature till date, with none of them in the suprasellar location.

Case report: A 40-year-old female patient presented with history of headache since two months, which was sudden in onset, holocranial.

Conclusions: Spontaneous intracystic hemorrhage is an uncommon and serious complication of arachnoid cysts, which can give rise to atypical features on imaging. Therefore familiarity with this rare complication is indeed essential.

Keywords: Arachnoid Cysts; Intracranial Hemorrhages; Magnetic Resonance Imaging.

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Figures

Figure 1
Figure 1
Axial section from a non-contrast CT of the head showing a well-defined, extra-axial lesion of attenuation of CSF in the suprasellar region extending towards the anterior skull base on the right side. A part of the lesion on the left side shows evidence of increased density.
Figure 2
Figure 2
Axial (A) and sagittal (B) T1-weighted MR images of the brain showing a hypointense signal similar to CSF in major portion of the sellar and suprasellar lesion with a thin septum. A part of the lesion on the left side of the septum shows a hyperintense signal. Coronal post-contrast T1-weighted image (C) of the brain showing non-enhancement in major portion of the lesion with smooth, thin rim enhancement in the left-sided locule.
Figure 3
Figure 3
Axial T2-weighted sequence of MRI showing uniform hyperintense signal within the lesion with a thin septum.
Figure 4
Figure 4
Axial diffusion-weighted image showing evidence of increased diffusivity within the lesion.
Figure 5
Figure 5
Peroperative photograph showing cyst visible in the inter optic and optico carotid space (A) and straw colored fluid being aspirated (B).
Figure 6
Figure 6
Low power view (100×) (A) and high power view (400×) (B) showing evidence of meningothelial cells within the cyst wall along with fibro-connective tissue. Immunohistochemistry showed positive staining with EMA (epithelial membrane antigen) in meningothelial cells (C) and with Vimentin (D).
See this image and copyright information in PMC

References

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