Investig Magn Reson Imaging.  2017 Sep;21(3):183-186. 10.13104/imri.2017.21.3.183.

Hemorrhagic Rupture of Arachnoid Cyst into the Intradural Space

• Choi SJ
• Lee HJ
• Hahm MH

• KMID: 2392690
• DOI: http://doi.org/10.13104/imri.2017.21.3.183

Abstract

A 7-year-old boy, diagnosed with an arachnoid cyst and subdural effusion on initial MRI, was admitted with left limb weakness and no history of head trauma. A subsequent follow-up MRI showed different stages of hematoma within multilayered enhancing membranes and in the arachnoid cyst, which was separated by the cerebrospinal fluid cleft. Craniotomy and fenestration of the cyst wall and hematoma removal were performed. The patient was diagnosed as a having a hemorrhagic rupture of an arachnoid cyst into the intradural space, probably via some one-way valve-like defect, based on the MRI and surgical findings. The MRI features and possible mechanism of this rare disease are discussed within the literature review.

Keyword

Arachnoid cyst; Hemorrhage; Dura mater; Magnetic resonance imaging; Hygroma

MeSH Terms

Arachnoid*
Cerebrospinal Fluid
Child
Craniocerebral Trauma
Craniotomy
Dura Mater
Extremities
Follow-Up Studies
Hematoma
Hemorrhage
Humans
Lymphangioma, Cystic
Magnetic Resonance Imaging
Male
Membranes
Rare Diseases
Rupture*
Subdural Effusion

Figure

• 

  Fig. 1 A 7-year-old boy with a hemorrhagic rupture of an arachnoid cyst into the intradural space. T2-weighted image (a) shows a cystic lesion covering the right frontal lobe. A low signal intensity linear structure (black arrow) divides the cystic space, which shows contrast enhancement (white arrow) on contrast enhanced T1-weighted image (b). Follow-up MRI three months later (c, d) shows three different cystic spaces. The high signal intensity tubular structure (black arrows) implies a torn vessel. The blood leaking from the ruptured vessel first filled the arachnoid cyst and then overflowed through the intradural space. Postoperative MRI (e, f) shows contour-bulging of the innermost cystic lesion (black arrow) after removal of hematoma and blood-filled cystic lesion. Schema using inverse imaging of T2-weighted image (g) shows three separated cysts (c1: arachnoid cyst; c2: intradural cyst; c3: subdural space), which are separated by a cerebrospinal fluid cleft and multilayer membranes (arrowhead: meningeal dura; double arrowheads: intermediate dura; triple arrowheads: periosteal dura). Tubular structure (black arrow) within the arachnoid cyst (c1) suggests a torn, unsupported vessel. Signal intensity of the cyst suggests one-way valve flow from c1 to c2 and bidirectional communication between c1 and c2.

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