REVIEW
Introdução: de acordo com a literatura, a ruptura ou sangramento dos cistos aracnoides (CA) são eventos incomuns geralmente causados por traumas, e, como pacientes jovens com CA têm uma probabilidade muito baixa de desenvolver um hematoma subdural espontâneo, o seguinte relato pode ser considerado relevante. Objetivo: descrever um caso raro de hematoma subdural espontâneo agudo associado a um cisto aracnoide ipsilateral, e estudá-lo por meio de uma revisão sistemática. Métodos: relato de caso e revisão sistemática, realizada em três bases de dados: PubMed, Embase e BVS. Resultados: foram identificados 2 relatos de uma série de casos, 2 relatos de caso associados a revisão narrativa, e 5 relatos de caso isolados, totalizando 9 referências selecionadas. Relato do caso: menino de 15 anos com dores de cabeça, vômitos e fotofobia por 5 semanas foi diagnosticado com um hematoma subdural no lado esquerdo. A avaliação neurológica mostrou sinais de hipertensão intracraniana. Este é um dos raros casos documentados de cisto aracnoide coexistindo com uma hemorragia subdural ipsilateral. Conclusão: hematomas subdurais espontâneos raramente estão ligados a cistos aracnoides, mas sintomas como papiledema, cefaleia e náuseas são úteis na triagem. A craniotomia é menos utilizada em prol de métodos menos invasivos. Houve um aumento de casos relatados em jovens e crianças devido à melhoria nos métodos diagnósticos.
Introduction: according to the literature, the rupture or bleeding of arachnoid cysts are uncommon events usually caused by trauma, and as young patients with arachnoid cysts have a very low probability of developing a spontaneous subdural hematoma, the following report may be considered relevant. Objective: to describe a rare case of acute spontaneous subdural hematoma associated with an ipsilateral arachnoid cyst and study it through a systematic review. Methods: case report and systematic review conducted on three literary databases: PubMed, Embase, and BVS. Results: two case series reports, two case reports associated with a narrative review, and five isolated case reports were identified, totaling nine selected references. Case presentation: a 15-year-old boy with headaches, vomiting, and photophobia for 5 weeks was diagnosed with a subdural hematoma on the left side. Neurological evaluation showed signs of intracranial hypertension. This is one of the rare documented cases of arachnoid cyst coexisting with an ipsilateral subdural hemorrhage. Conclusion: spontaneous subdural hematomas are rarely linked to arachnoid cysts, but symptoms such as papilledema, headache, and nausea are useful in screening. Craniotomy is less used in favor of less invasive methods. There has been an increase in reported cases in young people and children due to improvements in diagnostic methods.
1. Liu Z, Xu P, Li Q, Liu H, Chen N, Xu J. Arachnoid cysts with subdural hematoma or intracystic hemorrhage in children. Pediatr Emerg Care. 2014;30(5):345-51. http://dx.doi.org/10.1097/PEC.0000000000000128. PMid:24786991.
2. Arai H, Sato K, Wachi A, Okuda O, Takeda N. Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery. 1996;39(6):1108-13. http://dx.doi.org/10.1097/00006123-199612000-00007. PMid:8938764.
3. Rengachary SS, Watanabe I, Brackett CE. Pathogen- esis of intracranial arachnoid cysts. Surg Neurol. 1978;9(2):139-44. PMid:625699.
4. Gosalakkal JA. Intracranial arachnoid cysts in children: a review of pathogenesis, clinical features, and management. Pediatr Neurol. 2002;26(2):93-8. http://dx.doi.org/10.1016/S0887-8994(01)00329-0. PMid:11897472.
5. Henriques JGB, Pianetti G Fo, Henriques KSW, et al. Spontaneous acute subdural hematoma contralateral to an arachnoid cyst. Arq Neuropsiquiatr. 2007;65(4A):1034-6. http://dx.doi.org/10.1590/S0004- 282X2007000600025. PMid:18094872.
6. Greenberg MS. Handbook of neurosurgery. 7th ed. New York: Thieme; 2010.
7. Bervini D, Boscherini D, Tschuor S, Tosi C. Arachnoid cyst with intracystic haemorrhage and subdural haematoma: case report and literature review. Clin Neurophysiol. 2008;119(1):e3. http://dx.doi. org/10.1016/j.clinph.2007.09.073.
8. Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery. 1997;40(3):483-90. PMid:9055286.
9. Iaconetta G, Esposito M, Maiuri F, Cappabianca P. Arachnoid cyst with intracystic haemorrhage and subdural haematoma: case report and literature review. Neurol Sci. 2006;26(6):451-5. http://dx.doi. org/10.1007/s10072-006-0532-z. PMid:16601941.
10. Ibarra R, Kesava PP. Role of MR imaging in the diagnosis of complicated arachnoid cyst. Pediatr Radiol. 2000;30(5):329-31. http://dx.doi.org/10.1007/s002470050751. PMid:10836597.
11. Chandra VV, Prasad BC, Subramanium CS, Kumar R. Spontaneous intracystic hemorrhage complicating an intracranial arachnoid cyst. J Neurosci Rural Pract. 2015;6(4):629-30. http://dx.doi.org/10.4103/0976- 3147.169773. PMid:26752922.
12. Patel AP, Oliverio PJ, Kurtom KH, Roberti F. Spontaneous subdural hematoma and intracystic hemorrhage in an arachnoid cyst. Radiol Case Rep. 2009;4(3):298. http://dx.doi.org/10.2484/rcr.v4i3.298. PMid:27307821.
13. Shrestha R, You C. Spontaneous chronic subdural hematoma associated with arachnoid cyst in children and young adults. Asian J Neurosurg. 2014;9(3):168-72. http://dx.doi.org/10.4103/1793- 5482.142739. PMid:25685210.
14. Adin ME, Yıldız MS, Deniz MA, Behzadi AH, Mata-Mbemba D. Arachnoid cysts with spontaneous intracystic hemorrhage and associated subdural hematoma: report of management and follow-up of 2 cases. Radiol Case Rep. 2018;13(2):516-21. http://dx.doi.org/10.1016/j. radcr.2017.12.006. PMid:29904503.
15. Sayer FT, Alanezi AK, Zaidan SN. Spontaneous chronic subdural hematoma associated with arachnoid cyst in a child: a case report and critical review of the literature. Surg Neurol Int. 2022;13:156. http://dx.doi.org/10.25259/SNI_100_2022. PMid:35509549.
16. Hall A, White MAJ, Myles L. Spontaneous subdural haemorrhage from an arachnoid cyst: a case report and literature review. Br J Neurosurg. 2017;31(5):607-10. http://dx.doi.org/10.1080/02688697.2016.118725 5. PMid:27279460.
17. Parsch C, Krau J, Hoffman E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery. 1997;40:483-90. PMid:9055286.
18. Domenicucci M, Russo N, Giugni E, Pierallini A. Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment. J Neurosurg. 2009;110(6):1250-5. http://dx.doi.org/10.3171/2008.4.17509. PMid:18976058.
19. Kim DU, Park HR, Chang JC, Park SQ, Cho SJ, Park HK. Disappearance of arachnoid cyst after burrhole trephination: case series. Korean J Neurotrauma. 2019;15(2):170-5. http://dx.doi.org/10.13004/ kjnt.2019.15.e18. PMid:31720272.
20. Kim DY, Lee S, Choi BS, Kim JS. Spontaneous disappearance of an arachnoid cyst after burr hole drainage of chronic subdural hematoma. Korean J Neurotrauma. 2019;15(2):159-63. http://dx.doi.org/10.13004/ kjnt.2019.15.e15. PMid:31720270.
21. Kode S, Hegde A, Menon G. Chronic subdural hematoma associated with congenital arachnoid cysts: management dilemmas. Cureus. 2018;10(4):e2550. http://dx.doi.org/10.7759/cureus.2550. PMid:29974007.
1MS, Medical student, Positivo University, Curitiba, PR, Brazil.
2MD, Neurosurgeon, Department of Neurosurgery, Hospital Erasto Gaertner, Curitiba, PR, Brazil.
Received May 14, 2023
Corrected Jul 23, 2023
Accepted Jul 24, 2023
