Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports

A Kawanishi1, M Nakayama, K Kadota

  • 1Department of Neurosurgery, Kagoshima University School of Medicine.

Insights

Mild head trauma from soccer heading can cause subdural hematomas in children with middle cranial fossa arachnoid cysts. These cysts increase the risk of serious brain injury from minor impacts.

Area of Science:

  • Neurology
  • Pediatric Neurosurgery
  • Radiology

Background:

  • Arachnoid cysts in the middle cranial fossa are congenital brain malformations.
  • These cysts can be asymptomatic or present with various neurological symptoms.
  • Subdural hematomas are collections of blood between the dura mater and the arachnoid mater.

Observation:

  • Two pediatric patients presented with subdural hematomas.
  • Both patients had pre-existing arachnoid cysts in the middle cranial fossa.
  • Symptoms of raised intracranial pressure were observed in both cases.

Findings:

  • A history of heading a soccer ball was reported in both patients approximately 7 weeks prior to symptom onset.
  • No other significant head trauma was identified.
  • The subdural hematomas were considered complications of the arachnoid cysts, potentially triggered by mild head trauma.

Implications:

  • Mild head trauma, such as soccer heading, may be a significant risk factor for developing subdural hematomas in individuals with arachnoid cysts.
  • This highlights the importance of considering underlying pathologies like arachnoid cysts when evaluating head injuries in pediatric patients.
  • Further research is warranted to understand the biomechanics of heading injuries in the context of arachnoid cysts.

Related Concept Videos

Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Cranial and Spinal Meninges01:19

Cranial and Spinal Meninges

The cranial and spinal meninges are complex protective structures surrounding the central nervous system (CNS), consisting of the brain and spinal cord. These meninges consist of the dura mater, the arachnoid mater, and the pia mater. They protect the CNS, provide structural support, and aid in circulating cerebrospinal fluid (CSF).
Cranial Meninges
These meningeal layers cover the cranium. The dura mater is the outermost layer of cranial meninges. It is a thick and durable membrane of dense...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...