Severe head injuries
Brian Sindelar, Julian E. Bailes in Sports-Related Concussion, 2017
A high school female soccer athlete headed the ball during a routine play in a competition, causing her to be “stunned” but not lose consciousness. After evaluation, she was removed from play and received an uncomplicated, prompt graded return to activity. Unfortunately, 6 weeks after the incident, the player developed an acute onset seizure with right-sided numbness. CT brain imaging demonstrated a large subdural hematoma resulting from a ruptured arachnoid cyst (Figure 4.17). An arachnoid cyst is filled with cerebrospinal fluid encased within a layer of arachnoid. This usually asymptomatic, benign lesion is commonly found incidentally but may cause subdural hematomas due to bridging veins being draped over the cyst wall. Due to the patient’s neurological deficits, a craniotomy was performed to remove the hematoma and fenestrate the cyst wall. Despite her full recovery, she did not return to soccer.
Subdural hematoma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Infants, the elderly, and patients with alcoholism are groups at risk for developing SDHs. In the infant brain, SDHs are caused by the tearing of the bridging veins in the subdural space.3,6–8 Cerebral atrophy can occur in people over the age of 60, causing tension on the veins, which may then also be weaker and more susceptible to injury as a consequence of age.9 Arachnoid cysts are more commonly associated with CSDH in patients younger than 40 years.3 Alcohol misuse leads to a risk of thrombocytopenia (an abnormally low level of platelets), prolonged bleeding times, and blunt head trauma and is a risk factor for SDHs.
Test Paper 2
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Arachnoid cysts are CSF-containing intra-arachnoid cysts with ventricular communication or brain maldevelopment. They can be congenital or acquired (leptomeningeal cyst). Most are asymptomatic, but they can present with weakness, mass effect, seizure, headache, developmental delay or craniomegaly. The most common site is the middle cranial fossa anteriorly. On MRI, they are CSF density, well defined, low on T1-weighted and high on T2-weighted images, without enhancement or calcification. They can erode the inner table of the calvarium.
Management of quadrigeminal arachnoid cyst associated with obstructive hydrocephalus: report on stereotactic ventricular - cystic stenting
Published in British Journal of Neurosurgery, 2019
Yosef Laviv, Sergio Neto, Ekkehard M. Kasper
Arachnoid cysts [AC] are developmental abnormalities presenting as fluid filled cystic structures embedded in the arachnoid mater. While it is generally accepted that asymptomatic cases do not require any intervention, controversy still remains regarding the preferred treatment for symptomatic lesions. Management of ACs is further complicated by the presence of hydrocephalus. The prevalence of hydrocephalus associated with ACs is varied, ranging from 9%–66%. However, this association is location dependent, as the prevalence can be as high as 100% in cases of suprasellar ACs (foramen of Monroe obstruction), quadrigeminal ACs (QAC; aqueduct of Sylvius obstruction) and infratentorial ACs (4th ventricle obstruction).1–3
Pathogenesis, management strategies, and outcome of non-communicating extradural spinal arachnoid cyst (NEAC): a systematic review
Published in British Journal of Neurosurgery, 2023
Mohammad Shahidul Islam Khan, Nazmin Ahmed, Kanak Kanti Barua, Bipin Chaurasia, Atul Vats, Atul Goel
For asymptomatic patients, conservative treatment with observation and follow up is recommended.8,44,47 Complete surgical excision with primary dural closure or duraplasty is the treatment of choice for symptomatic lesion.36,49 Simple cyst drainage possesses a high recurrence rate with temporary relief only. If the cyst does not communicate with the subarachnoid space, complete excision can be performed without subsequent repair of the dural defect (Figure 5). In presence of communicating pedicle, onlay dural grafting by muscle patch, augmented by fibrin glue should be considered before taking decision regarding cysto peritoneal shunt. On the other hand, when dural defect is large and not amenable to repair then cysto peritoneal shunt is a good option.41 Tanaka et al. reported an extradural arachnoid cyst in the lumbosacral region for which they managed the case by ligating the pedicle and marsupialize the cyst.47 Sometimes, cyst wall tightly adhere with nerve root, in that case cyst has to be fenestrated or marsupialize to relieve the compression. Now a days, minimally invasive surgery gains popularity for treating arachnoid cysts. Ying et al. reported a case of communicating variety of spinal arachnoid cyst where they injected contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula.49 Confirming the location of fistula enabled them to perform minimally invasive surgery to ligate the fistula. Besides this, often large cyst required extensive laminectomy/laminoplasty (Figure 6).50
Spinal intradural arachnoid cyst associated with diastematomyelia in an adult: a case report and review of literature
Published in British Journal of Neurosurgery, 2023
This case was a diagnostic dilemma. There were two possibilities to be considered. The cystic lesion could be a cystic degeneration in the spinal cord due to ischaemic necrosis, which occurs in untreated tethered cord. The second possibility was of an extramedullary lesion compressing the cord. The clinical picture did not favour an intramedullary lesion as there were no disturbance of bladder and bowel function and the sacral sensation and anal tone were normal. On MRI, the axial section showed two hemi-cords above the level of the lesion. However, at the level of the lesion the cyst the left hemi-cord was barely discernible. The diagnosis of an arachnoid cyst was only confirmed intra-operatively.
Related Knowledge Centers
- Arachnoid Mater
- Birth Defect
- Cerebrospinal Fluid
- Collagen
- Meninges
- Attention Deficit Hyperactivity Disorder
- Spinal Cord
- Brain
- Macrocephaly
- Bobble-Head Doll Syndrome