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Ophthalmic manifestations of ruptured arachnoid cysts in children
Maxwell S Mayeda1, Jennifer L Jung2, Emily A McCourt2
1University of Colorado School of Medicine, Aurora.
Insights
Ruptured arachnoid cysts in children can cause serious eye problems like papilledema and vision loss. Prompt ophthalmological evaluation is crucial for managing these pediatric neurological emergencies.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuroimaging
Background:
- Intracranial arachnoid cysts are common in children.
- Rupture of these cysts can lead to acute subdural fluid collections and increased intracranial pressure.
- Ophthalmic complications following cyst rupture are not well-characterized.
Purpose of the Study:
- To characterize the ophthalmic sequelae in a large cohort of pediatric patients with ruptured intracranial arachnoid cysts.
- To identify common ophthalmological findings and visual outcomes.
Main Methods:
- Retrospective review of medical records of children treated for ruptured arachnoid cysts at a tertiary pediatric hospital (2009-2021).
- Ophthalmological examinations were performed on a subset of patients.
- Data on visual acuity, cranial nerve palsies, and retinal findings were analyzed.
Main Results:
- Papilledema occurred in 57% of examined children.
- Abducens palsy was present in 20%, and retinal hemorrhages in 10%.
- Five children (17%) had reduced visual acuity (≥20/40) at follow-up; cranial nerve palsies resolved without surgery.
Conclusions:
- Ruptured arachnoid cysts frequently cause significant ophthalmic issues in children.
- High rates of papilledema and potential vision loss necessitate comprehensive eye exams.
- Pediatric ophthalmologist consultation is recommended for all children diagnosed with ruptured arachnoid cysts.
Background:
Intracranial arachnoid cysts are relatively common in the pediatric population. Rarely, they rupture, leading to acute subdural fluid collections, which can cause a sudden increase in intracranial pressure. The purpose of this study was to characterize ophthalmic sequelae in a large cohort of these patients.
Methods:
The medical records of all children treated for ruptured arachnoid cysts who presented at a single tertiary pediatric hospital for initial assessment between 2009 and 2021 were reviewed retrospectively.
Results:
Of 35 children treated for ruptured arachnoid cysts during the study period, 30 received ophthalmological examination. Papilledema was found in 57% of these children, abducens palsy in 20%, and retinal hemorrhages in 10%. Of the 30 children, 22 were seen in outpatient follow-up, of whom 5 had a best-corrected visual acuity of 20/40 or worse in one or both eyes at most recent follow-up. Cranial nerve palsies resolved in all cases without strabismus surgery.
Conclusions:
Given high rates of papilledema, cranial nerve palsies, and vision loss, all children with ruptured arachnoid cysts should be evaluated by pediatric ophthalmologists.
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