Non-Operative Management of a Pediatric Patient With Bilateral Subdural Hematomas in the Setting of Ruptured Arachnoid Cyst

Boyi Li,Michael Tobias,Christina Ng,Eric Feldstein,Carrie Muh,Avinash Mohan

doi:10.7759/cureus.20099

Boyi Li, Michael Tobias + Show 4 more

Open Access

https://doi.org/10.7759/cureus.20099

Copy DOI

Journal: Cureus	Publication Date: Dec 2, 2021
Citations: 3	License type: cc-by

Affiliation: University of North Carolina at Chapel Hill

Abstract

Pediatric subdural hematomas (SDH) are associated with arachnoid cysts (AC), particularly in the middle cranial fossa (MCF). Operative management of these hemorrhages is a mainstay of treatment. Conservative management may be an option if there is minimal mass effect and the patient is mildly symptomatic. A 14-year-old male presented with right frontal headaches that worsened with activity. He was found to have a large right MCF AC. Scheduled routine outpatient follow-up CT of the head demonstrated bilateral SDH. There was no history of significant head trauma. He was admitted for close observation and his inpatient scans remained stable. Outpatient follow-up imaging over the course of three and a half years demonstrated resolution of SDH and decreased AC size. He denied headaches and continued doing well in school. ACs are a risk factor for the development of SDH in young male patients after minor trauma. Development of intracranial hypotension secondary to AC rupture may have contributed to the development of bilateral SDH in our patient. We demonstrate here that close clinical follow up with serial imaging may be considered a management strategy in these patients.

Highlights

Arachnoid cysts (AC) are cerebrospinal fluid (CSF) filled spaces that are non-neoplastic, with the majority of them (50%-65%) found in the middle cranial fossa (MCF) [1,2,3]
Chronic subdural hematomas (SDH) is associated with AC [12]
The pediatric age group makes up 30%-42% of AC chronic SDH patients, with up to 86% of these patients having the AC in the MCF [11,16]

Summary

Introduction

Arachnoid cysts (AC) are cerebrospinal fluid (CSF) filled spaces that are non-neoplastic, with the majority of them (50%-65%) found in the middle cranial fossa (MCF) [1,2,3]. How to cite this article Li B, Ng C, Feldstein E, et al (December 02, 2021) Non-Operative Management of a Pediatric Patient With Bilateral Subdural Hematomas in the Setting of Ruptured Arachnoid Cyst. On his routine follow-up CT head, a new right chronic SDH and a new left acute SDH was found (Figure 2). He was brought in to the emergency room for evaluation where he was found to be neurologically intact but endorsed two recent episodes of morning emesis. As of 3.5 years later, the patient is doing excellent clinically and his MRI brain demonstrates resolution of bilateral SDH and decreased size of the AC (Figure 4). The patient remains asymptomatic and is doing well in school

Discussion

Findings

Conclusions

Disclosures