Öncesinde Asemptomatik Olan Subdural Higroma İle Seyreden Spontan Araknoid Kist Rüptürü: Olgu Sunumu

Year 2021, Volume: 4 Issue: 4, 146 - 148, 29.12.2021

Ercan Nalbant , Mehmet Altuntaş

https://doi.org/10.54996/anatolianjem.1011297

Abstract

Amaç: Araknoid kistin subdural higroma ile sonuçlanan spontan rüptürü nadir görülen bir olaydır. Daha önce nörogörüntüleme yapılmamış ve travmaya bağlı olmayan akut başlangıçlı baş ağrısı, baş dönmesi ve mide bulantısı olan yetişkin bir hastayı sunuyoruz.

Olgu: 67 yaşında erkek hasta bahçede çalışırken aniden başlayan baş dönmesi, baş ağrısı ve kusma şikayetleriyle acil servise getirildi. Frontal bölgeye lokalize devam eden bulantı ve baş ağrısı tarif etti. Semptomatik tedavisi devam ederken bulantı ve baş dönmesi artan hastaya beyin BT görüntüleme planlandı. Beyin BT'sinde sağ serebral hemisferde orta fossadan başlayıp frontoparietal bölgede konveksite seviyesine kadar uzanan alanda geniş hipodens ekstraserebral koleksiyon saptandı. Hasta beyin cerrahisi ünitesinde konsülte edildi. Cerrahi müdahale düşünülmedi ve hasta tedavi için beyin cerrahisi servisine yatırıldı. Servis takiplerindeki asemptomatik seyir nedeniyle poliklinik kontrol önerileri ile taburcu edildi.

Sonuç: Bu vaka, araknoid kistin spontan rüptürü olasılığını bilmenin önemini göstermektedir. Bu fenomen kafa travması olmayan hastalarda ayırıcı tanı olarak düşünülmelidir. Nadir de olsa böyle bir durumun farkında olmak olası kötü sonuçların önlenmesinde yardımcı olur.

Keywords

Araknoid kist, subdural higroma, beyin cerrahisi

Spontaneous Arachnoid Cyst Rupture With Subdural Hygroma in a Previously Asymptomatic Man: Case Report

Abstract

Aim: Spontaneous rupture of an arachnoid cyst resulting in a subdural hygroma is an infrequent event. We report an adult patient who had no previous neuroimaging and had acute onset headache, dizziness, and nausea unrelated to trauma.

Case: A 67-year-old male patient was brought to the emergency service complaints of sudden onset of dizziness, headache, and vomiting while working in the garden. He described ongoing nausea and headache localized to the frontal region. Brain CT imaging was planned for the patient whose nausea and dizziness worsened while his symptomatic treatment continued. In the brain CT, a large hypodense extracerebral collection was detected in the area starting from the middle fossa in the right cerebral hemisphere and extending to the convexity level in the frontoparietal region. The patient was consulted in the neurosurgery unit. Surgical intervention was not considered, and the patient was admitted to the neurosurgery service for treatment. Due to the asymptomatic course in the service follow-ups, he was discharged with outpatient clinic control recommendations.

Conclusion: This case illustrates the importance of recognizing the possibility of spontaneous rupture of an arachnoid cyst. This phenomenon should be considered as a differential diagnosis in patients without head trauma. Although it is rare, being aware of such a case is helpful in preventing possible bad outcomes.

Keywords

Arachnoid Cyst, subdural hygroma, brain surgery

References

• Al-Holou WN, Terman S, Kilburg C,et al. Prevalence And Natural History Of Arachnoid Cysts in Adults. J Neurosurg. 2013 Feb;118(2):222-31. doi: 10.3171/2012.10.JNS12548. Epub 2012 Nov 9.
• Rajesh A, Bramhaprasa, V, Purohıt AK. Traumatic Rupture Of Arachnoid Cyst With Subdural Hygroma. J Pediatr Neurosci. 2012 Jan;7(1):33-5. doi: 10.4103/1817-1745.97620.
• Gosalakkal JA. Intracranial Arachnoid Cysts İn Children: A Review Of Pathogenesis, Clinical Features, And Management. Pediatr Neurol. 2002 Feb;26(2):93-8. doi: 10.1016/s0887-8994(01)00329-0.
• Adin ME, Yıldız MS, Deniz MA, et al. Arachnoid Cysts With Spontaneous İntracystic Hemorrhage and Associated Subdural Hematoma: Report Of Management And Follow-Up Of 2 Cases. Radiol Case Rep. 2017 Dec 29;13(2):516-521. doi: 10.1016/j.radcr.2017.12.006.
• Khilji, MF, Jeswani NL, Hamid RS, et al. Spontaneous Arachnoid Cyst Rupture With Subdural Hygroma in a Child. Case Rep Emerg Med. 2016;2016:6964713. doi: 10.1155/2016/6964713. Epub 2016 Feb 18.
• Bora A, Yokuş A, Batur A, et al. Spontaneous Rupture Of The Middle Fossa Arachnoid Cyst Into The Subdural Space: Case Report. Pol J Radiol. 2015 Jun 22;80:324-7. doi: 10.12659/PJR.893928.
• Balestrino A, Piatelli G, Consales A, et Al. Spontaneous Rupture of Middle Fossa Arachnoid Cysts: Surgical Series From a Single Center Pediatric Hospital and Literature Review. Childs Nerv Syst. 2020 Nov;36(11):2789-2799. doi: 10.1007/s00381-020-04560-3.
• Hall S, Smedley A, Sparrow O, et al. Natural History of İntracranial Arachnoid Cysts. World Neurosurg. 2019 Jun;126:e1315-e1320. doi: 10.1016/j.wneu.2019.03.087.
• Lee JY, Kim JW, Phi JH, et Al. Enlarging Arachnoid Cyst: A False Alarm for Infants. Childs Nerv Syst. 2012 Aug;28(8):1203-11. doi: 10.1007/s00381-012-1722-z.
• Schulz, M, Kimura T, Akiyama O, et al. Endoscopic And Microsurgical Treatment of Sylvian Fissure Arachnoid Cysts—Clinical And Radiological Outcome. World Neurosurg. 2015 Aug;84(2):327-36. doi: 10.1016/j.wneu.2015.03.026.
• Chen Y, Fang HJ, Li ZF, et Al. Treatment of Middle Cranial Fossa Arachnoid Cysts: A Systematic Review And Meta-Analysis. World Neurosurg. 2016 Aug;92:480-490.e2. doi: 10.1016/j.wneu.2016.06.046.