Presentation
Post road traffic accident and head trauma, the patient is being evaluated for intracranial hemorrhage or skull fracture.
Patient Data
Hyperdensity of the left tentorium and over the petrous apex is consistent with a subdural hematoma. Subgaleal hematoma and subcutaneous emphysema are overlying the top of the skull.
There is a uniform fluid density cyst in the left middle cranial fossa with smooth margins and non-enhancing walls outside the left temporal lobe causing a displaced inferior part of the temporal lobe posteriorly.
The cyst extended superiorly into the Sylvian fissure and produced a mass effect with a slightly superiorly displaced and compressed left lateral ventricle.
No evidence of acute ischemia. No intra or extra-axial hemorrhage is seen. No hydrocephalus.
Case Discussion
The findings in our case post-head trauma were mostly of a small left subdural hematoma but it was also noted there was an incidental left middle cranial fossa arachnoid cyst. According to the Galassi classification of middle cranial fossa arachnoid cysts, it is type II. Most patients with arachnoid cysts are asymptomatic, and such cysts are often incidentally discovered, as in our case, which presented post-head trauma.
Usually, the patient undergoes surgical treatment of the arachnoid cyst only if symptomatic due to the cyst's large size causing significant mass effect or if the cyst has ruptured.
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