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A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a
Anne Bryden1, Natalie Majors2, Vinay Puri3
1Department of Neurology and Pediatrics, University of Louisville SOM, Louisville, KY 40202, USA.
Insights
A ruptured arachnoid cyst (AC) caused acute neurological symptoms in a child. Expectant management led to a full recovery, highlighting the importance of monitoring ACs.
Area of Science:
- Neurology
- Pediatric Neurology
- Neurosurgery
Background:
- Arachnoid cysts (ACs) are typically benign, often asymptomatic congenital malformations.
- Large ACs, though usually asymptomatic, carry a potential risk of complications.
Observation:
- An 11-year-old boy with a known large arachnoid cyst presented with acute right facial droop, hemiplegia, and expressive aphasia.
- Neurological deficits partially resolved, but headache and word-finding difficulties persisted.
- Brain MRI revealed a subdural hematohygroma and edema secondary to a ruptured arachnoid cyst.
Findings:
- Rupture of a previously asymptomatic arachnoid cyst led to acute neurological deficits.
- Subdural hematohygroma and cerebral edema were identified as complications.
- Expectant management was successful, with the patient recovering uneventfully.
Implications:
- This case underscores the potential for sudden complications from previously asymptomatic arachnoid cysts.
- It highlights the importance of neuroimaging in diagnosing acute neurological changes in pediatric patients.
- Conservative management can be effective for certain arachnoid cyst complications.
Abstract:
This study examines an 11-year-old boy with a known history of a large previously asymptomatic arachnoid cyst (AC) presenting with acute onset of right facial droop, hemiplegia, and expressive aphasia. Shortly after arrival to the emergency department, the patient exhibited complete resolution of right-sided hemiplegia but developed headache and had persistent word-finding difficulties. Prior to symptom onset while in class at school, there was an absence of reported jerking movements, headache, photophobia, fever, or trauma. At the time of neurology consultation, the physical exam showed mildly delayed cognitive processing but was otherwise unremarkable. The patient underwent MRI scanning of the brain, which revealed left convexity subdural hematohygroma and perirolandic cortex edema resulting from ruptured left frontoparietal AC. He was evaluated by neurosurgery and managed expectantly. He recovered uneventfully and was discharged two days after presentation remaining asymptomatic on subsequent outpatient visits. The family express concerns regarding increased anxiety and mild memory loss since hospitalization.
