Subdural hemorrhage in middle cranial fossa arachnoid cysts: a report of two cases at two ends of the spectrum

Arachnoid cysts are usually asymptomatic, benign lesions commonly occurring in the middle cranial fossa. However, the cysts may rupture in rare cases causing intracystic or subdural hemorrhages with significant mass effect. We report two cases of middle cranial fossa arachnoid cyst with subdural hemorrhage with very different clinical course. The first case presented with significant mass effect with cerebral herniation and had significant neurological morbidity post-surgery. The second case had minimal symptoms and was managed conservatively with offer of elective surgery. The report underscores the importance of prompt diagnosis and appropriate surgical intervention in managing arachnoid cysts with hemorrhage, highlighting the potential for diverse clinical presentations and outcomes.

Automated summary

Arachnoid cysts in the middle cranial fossa are usually benign and asymptomatic, but in rare cases, they can rupture and lead to hemorrhages causing significant mass effect. We present two cases with subdural hemorrhage from middle cranial fossa arachnoid cyst, demonstrating very different clinical outcomes. Prompt diagnosis and appropriate surgical intervention are important in managing arachnoid cysts with hemorrhage, as these cases can have diverse clinical presentations and outcomes.