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Case Reports
. 2025 Jul 17;17(7):e88183.
doi: 10.7759/cureus.88183. eCollection 2025 Jul.

An Adolescent Football Player With Persistent Headaches Following a Concussion: A Case of Primary Arachnoid Cyst

Jonathan R Guin  1 , Ryan Moran  2 , Earl R Stewart  1 , Brett C Bentley  1
Affiliations
Case Reports

An Adolescent Football Player With Persistent Headaches Following a Concussion: A Case of Primary Arachnoid Cyst

Jonathan R Guin et al. Cureus. .

Abstract

Post-concussion syndrome (PCS) is a common sequela of mild traumatic brain injury in adolescent athletes, typically resolving within weeks. However, persistent or atypical symptoms warrant further investigation to exclude structural pathology. Arachnoid cysts, though often incidental, can become symptomatic following trauma and may mimic or exacerbate PCS. A previously healthy adolescent American football player presented with persistent headaches and cognitive symptoms 14 weeks after a sports-related concussion. Despite completing a return-to-play protocol, his symptoms worsened. A brain MRI revealed a large left-sided arachnoid cyst with a 5 mm midline shift, consistent with a primary arachnoid cyst. The patient was admitted to the medical unit of the pediatric hospital for monitoring on the medical floor with 48 hours of observation and repeat imaging to verify that the MRI findings were not worsening. Serial imaging over three months demonstrated regression of the cyst and resolution of mass effect. He remained asymptomatic at follow-up but was permanently restricted from contact sports. This case underscores the importance of considering structural brain lesions in athletes with prolonged or atypical post-concussive symptoms. MRI played a critical role in identifying a potentially life-threatening condition that mimicked PCS. Conservative management may be appropriate in select cases of arachnoid cysts with favorable clinical and radiographic progression. Surgical management may be necessary in cases of increased intracranial pressure, neurologic deficit, or radiographic progression.

Keywords: brain concussion; congenital arachnoid cyst; management of arachnoid cyst; pediatric sports medicine; post-concussion headache.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Timeline of case presentation including initial injury, diagnosis, and management from early September to March of the following year.
Figure 2
Figure 2. Axial T2-weighted brain MRI without contrast using the PROPELLER technique demonstrating 22.25 mm left temporal arachnoid cyst causing sulcal effacement.
PROPELLER technique: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction
Figure 3
Figure 3. Axial T2-weighted brain MRI without contrast, using the PROPELLER technique, demonstrates a left cerebral hemisphere arachnoid cyst measuring 45.94 mm (left to right) × 38.16 mm, located caudally at the level of the orbits within the cranium, with partial compression of the left lateral ventricle.
PROPELLER technique: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction
Figure 4
Figure 4. Axial T2-weighted brain MRI without contrast using the PROPELLER technique demonstrating a 5 mm midline shift from the arachnoid cyst.
PROPELLER technique: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction
See this image and copyright information in PMC

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