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Episodic Headache and Arachnoid Cyst Related Subdural Hematoma
Author(s) -
Rashid Salman,
Watson Carla,
Agarwal Rajkumar
Publication year - 2016
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12846
Subject(s) - watson , medicine , emergency department , neurology , pediatrics , psychology , psychiatry , artificial intelligence , computer science
A 7-year-old boy presented with a 1-month history of episodic bifrontal throbbing headache associated with photophobia, bilateral painful arm paresthesias, and intense agitation. Symptoms developed 2 weeks after a trivial trampoline fall causing blunt head trauma without loss of consciousness. Three interval emergency room visits led to transient improvement with intravenous analgesics. During this (fourth) visit, additional symptoms included binocular diplopia. Examination showed excessive irritability but was negative for focal neurological signs or obvious eye movement abnormalities. A brain magnetic resonance imaging (MRI) completed during this encounter showed bilateral arachnoid cysts with hemorrhage and evidence of transtentorial herniation (Fig. 1). Surgical evacuation of hematomas resulted in dramatic recovery. Chronic subdural hematoma (CSDH) is a rare complication of an arachnoid cyst reported in children as young as 3 years. Although the pathogenesis is contentious, CSDH may occur due to a trivial or an unrecognized trauma. Patients may present with worsening headache and focal neurological deficits due to elevated intracranial pressure. Migraine-like headaches, likely related to cortical spreading depression triggered by the CSDH, have also been described. The presence of irritability, diplopia, and recent head trauma constitute “red flags” in a child with new onset headache and should warrant further investigation.