A. Meyer-Bahlburg (Halle), Carsten Bock (Halle)  

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1 Years  

Female  

Head-Brain and brain nerves  

unknown  

2.5 year-old girl with acute, incomplete hemiparalysis of the right side. Up until now, the child developed normally. Sensitivity lost in the right arm and leg region.  

This deals with fluid filled cavities within the arachnoid. Most frequently, this occurs in the middle cranial fossa (about 2/3 of the cases, left more frequent than right), furthermore, in the sella region and in the posterior cranial fossa.

Arachnoid cysts are more commonly associated with cerebral anomalies (hypoplasia of the temporal lobe), where it is unclear if these are primarily or secondarily formed.  

<- view MRI 1

MRI 1: (T2-FLAIR-Sequence, transversal): Large, temporally located cyst on the left side (5.5 x 8 x 8.5 cm), which causes a median shift due to compression of the left lateral ventricle.







<- view MRI 2

MRI 2: T1 SE-coronal after contrast application: Cystic mass in the left temporal lobe, which is seen compressed.







<- view MRI 3

MRI 3: T2-FLAIR transversal following surgery: Expansion of the previously compressed temporal lobe. In this slice, one sees the complete cerebral parenchymal filling of the area where the cyst was previously located.







<- view MRI 4

MRI 4: T2- TSE-FS transversal following surgery: Expansion of the previously compressed temporal lobe. In this slice, one sees the complete cerebral parenchymal filling of the area where the cyst was previously located.
In the area of of the lenticulostratal artery on the left side there is a striped area of infarction - assumed to be a result of the expansion and compression of the cyst (yellow arrow).




<- view MRI 5

MRI 5: T1-SE coronal after contrast application: After surgical windowing, a regression of size of the cyst is seen. There is no median shift. After windowing, a hygroma (left) is seen parietally (often after removal of cysts). Here one sees the area of infarction as well (arrow).

 

Surgery / Histo  

N/A  

Occurs about 1:1000; male:female about 2:1
Symptoms depend on the localisation
With small cysts, no symptoms (chance findings)
With large cysts, macrocephalus, developmental retardation, change in personality, seizures, headaches, paralysis, bitemporal hemianopsy, hydrocephalus or cerebellar (nystagmus, ataxia).

Treatment: Relief of the cyst by windowing or shunt placement.  

Windowing of the arachnoid cyst in the basal cisterns.

In the course of a few days after windowing, there was a complete regression of the incomplete hemiparalysis, complete regeneration of the sensibility.  

N/A  

1. Medline:
Gosalakkal
Intracranial Arachnoid Cysts in Children: A review of pathogenesis, clinical features, and management
Pediatr Neurol 2002;26::93-98  

Loss of sensibility, sella, skull, arachnoidal cyst, cerebral infarction, brain, stroke, CVA, arachnoid cyst, child, childhood, pediatric radiology  

A Meyer-Bahlburg, Carsten Bock. Arachnoid cyst as a cause of cerebral infarction. PedRad [serial online] vol 2, no. 8.
URL: www.PedRad.info/?search=20020814135433