Quiste aracnoideo complicado con hemorragia intraquística y hematoma subdural espontáneo: hallazgos en resonancia magnética

Concomitant spontaneous subdural and intracystic hematoma in arachnoid cyst: a case report and review of the literature

BACKGROUND

Intracystic hematoma in arachnoid cyst are a very rare pathology that commonly occurs after head trauma, while spontaneous intracystic hematomas in arachnoid cyst associated with subdural hematoma is extremely rare. Currently there are 33 patients of spontaneous intracystic hematomas in arachnoid cyst reported in the literature. In this case report we present an adult patient with concomitant chronic subdural hematoma with intracystic hematoma in arachnoid cyst.

CASE PRESENTATION

A 19-year-old Egyptian Arabian female patient presented to the outpatient clinic complaining of severe headache of 1-month duration that was progressive in nature. Provisionally, it was thought that it might be an arachnoid cyst with associated chronic subdural hematoma along with intracystic hematoma. Decision to proceed with craniotomy and cyst evacuation was made.

CONCLUSION

Concomitant intracystic hematoma in arachnoid cyst along with subdural hematoma is a serious condition that might be life-threatening if not well managed.

[Imaging diagnosis of arachnoid cysts]

Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.

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

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.

Arachnoid cysts with subdural hematoma or intracystic hemorrhage in children

Arachnoid cyst (AC) is a common congenital intracranial lesion in children. It may be complicated by subdural hematoma (SDH) and intracystic hemorrhage (ICH) to cause intracranial hypertension after minor head injury or spontaneously. However, because most bleeding after trauma is delayed, it is often overlooked. At the same time, it remains controversial for treatment of ACs complicated with SDH and ICH. So far, it lacks review, especially for pediatric patients who have ACs with SDH or ICH. Here, we report 3 pediatric cases in our department from 2010 to 2011. At the same time, we review 41 pediatric patients reported in the last 20 years. We conclude that a child with AC should be regularly followed up after minor head injury, and that therapy for children with complicated ACs should be more aggressive than for adults. The cyst wall should be resected, and communication between cyst and cerebral cistern should be established.

Arachnoid cyst associated with subdural hematoma: report of three cases and review of the literature

INTRODUCTION

Arachnoid cysts are usually found incidentally and are generally asymptomatic. They are thought to be developmental anomalies, and their etiology is unknown. Some complications such as subdural hematoma, subdural hygroma, and intracystic bleeding can occur after minor traumas.

CASE REPORT

Here, we report three cases. Case 1 has subdural hematoma associated with subdural hygroma, case 2 has subdural hematoma after a birth delivery, and case 3 has intracystic bleeding associated with subdural hematoma.

DISCUSSION

We suggest to treat the complicating event in our patients and have chosen burr-hole evacuation for treatment.