Chronic subdural haematoma associated with arachnoid cyst of the middle fossa in a soccer player: Case report and review of the literature
Main Article Content
Abstract
Introduction: Arachnoid cyst (AC) is a congenital, benign, extra-axial lesion often found incidentally on intracranial imaging and makes up almost 1% of all intracranial masses. It arises from the splitting of arachnoid membranes with components similar to the cerebrospinal fluid. It’s reported that AC can be complicated by chronic subdural haematoma in athletes with repeated head injuries.
Case report: we describe a case of a soccer player with an AC that underwent surgery for a chronic subdural haematoma with full recovery.
Material and method: From a PubMed research, we found 14 relevant studies reporting a total of 15 patients who met the inclusion criteria: playing soccer, subdural hematoma and arachnoid cyst.
Results: Patients underwent different surgical treatment. In the case of hygroma with no midline shift, a conservative treatment was performed. In all cases the reported follow up was a full recovery.
Discussion: Soccer is not usually considered a contact sport related to a high risk of head trauma or shaking head. From our review we can postulate that a soccer player with AC has an augmented risk to have a subdural haemorrhage, more rarely intracerebral haemorrhage.
Conclusion: ACs are common meningeal abnormalities. They may bleed after minor head trauma, although it is rare. Asymptomatic patients with known AC should be monitored by a neurosurgeon and decision to engage this patient in soccer sport participation is still controversial.
Article Details
Copyright (c) 2020 Beretta E, et al.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Archives of Case Reports is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.
License: Copyright © 2017 - 2025 | Open Access by Archives of Case Reports is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.
With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.
Compliance 'CC BY' license helps in:
Permission to read and download | ✓ |
Permission to display in a repository | ✓ |
Permission to translate | ✓ |
Commercial uses of manuscript | ✓ |
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
Galassi E, Pazza G, Gaist G, Giuliani G, Pozzati E. Arachnoid cysts of the middle cranial fossa: experience with 77 cases treated surgically. Acta Neurochir Suppl (Wien) 1988; 42: 201-204. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3189009
Heier LA, Zimmermann RD, Amster JL, Gandy SE, Deck MD. Magnetic resonance imaging of arachnoid cyst. Clin Imaging 1989; 13:281-291. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2598110
Wester K. Peculiarities of intracranial arachnoid cysts: location, sidedness, and sex distribution in 126 consecutive patients. Neurosurgery. 1999; 45: 775-779. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10515470
Lee KS. Natural history of chronic subdural hematomas: a review. J Neurosurg. 2004; 18:351-358. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14742149
Miele VJ, Bailes JE, Martin NA. Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy. Neurosurg Focus. 2006; 21: E9. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17112199
Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, et al. CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol. 1982; 17: 363-369. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7089853
Oliver L. C. Primary arachnoid cysts; report of two cases. Br Med J. 1958; 1:1147-1149. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/13536443
Maeda M, Kawamura Y, Handa Y, Kubota T, Ishii Y. Value of MR imaging in middle fossa arachnoid cyst with intracystic and subdural hematoma. Eur J Radiol. 1993; 17: 145-147. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8293737
Kawanishi A, Nakayama M, Kadota K. Heading injury precipitating subdural hematoma associated with arachnoid cysts-two case reports. Neurol Med Chir (Tokyo). 1999; 39: 231-233. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10344112
Chillala S, Read C, Evans PA. An unusual case of subdural haematoma presenting to the accident and emergency department. Emerg Med J. 2001; 18: 308-309. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11435376
Prabhu VC, Bailes JE. Chronic subdural hematoma complicating arachnoid cyst secondary to soccer-related head injury: case report. Neurosurgery. 2002; 50:195-197. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11844251
Demetriades AK, McEvoy AW, Kitchen ND. Subdural haematoma associated with an arachnoid cyst after repetitive minor heading injury in ball games. Br J Sports Med. 2004; 38: E8. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15273201
Offiah C, St Clair Forbes W, Thorne J. Non-haemorrhagic subdural collection complicating rupture of a middle cranial fossa arachnoid cyst. Br J Radiol. 2006; 79:79–82. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16421410
Domenicucci M, Russo N, Giugni E, Pierallini A. Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment. J Neurosurg. 2009; 110: 1250-1255. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18976058
Zeng T, Shi SS, Lin YF. Chronic subdural hematoma associated with sylvian arachnoid cyst in juvenile athletes: report of two cases and literature review. Chin J Traumatol. 2011; 14: 174-177. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21635806
Isik HS, Yildiz O, Ceylan Y. Chronic subdural hematoma caused by soccer ball trauma associated with arachnoid cyst in childhood: case report. J Neurol Sci (Turk). 2011; 28: 398-401.
Maher CO, Garton HJ, Al-Holou WN, Trobe JD, Muraszko KM, et al. Management of subdural hygromas associated with arachnoid cysts. J Neurosurg Pediatr. 2013; 12: 434-443. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24011368
Edmondson L, Upshaw JE, Tuuri RE. A 14-year-old male with a 10-week history of headaches. Pediatr Ann. 2014;43: 222-223. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24972416
Takizawa K, Sorimachi T, Honda Y, Ishizaka H, Baba T, et al. Chronic Subdural Hematomas Associated with Arachnoid Cysts: Significance in Young Patients with Chronic Subdural Hematomas. Neurol Med Chir (Tokyo). 2015; 55: 727-734. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605080/
Wu X, Li G, Zhao J, Zhu X, Zhang Y, Hou K. Arachnoid Cyst-Associated Chronic Subdural Hematoma: Report of 14 Cases and a Systematic Literature Review. World Neurosurg. 2018; 109:118-130. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28962953
Sun J, Wang W, Wang D, An S, Xue L, et al. Clinical analysis of 10 patients of chronic subdural hematoma associated with arachnoid cyst. Zhonghua Yi Xue Za Zhi. 2017; 23; 97: 1502-1504. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28535643
Cress M, Kestle JR, Holubkov R, Riva-Cambrin J. Risk factors for pediatric arachnoid cyst rupture/hemorrhage: a case-control study. Neurosurgery. 2013; 72: 716-722. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23313978
Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA. 1999; 282: 36-39. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10404909
Wester K, Helland CA. How often do chronic extra-cerebral haematomas occur in patients with intracranial arachnoid cysts? J Neurol Neurosurg Psychiatry. 2008; 79: 72-75. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17488784
Al-Holou WN, Terman S, Kilburg C, Garton HJ, Muraszko KM, et al. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg. 2013; 118: 222-231. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23140149
Robinson R. Congenital cyst of the brain: arachnoid malformations. Progr Neurosurg 1971; 4: 133-174.
LaCour F, Trevor R, Carey M. Arachnoid cyst and associated subdural hematoma. Observations on conventional roentgenographic and computerized tomographic diagnosis. Arch Neurol. 1978; 35: 84-89. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/623534
Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1987; 50:1001-1007. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3655804
Takayasu T, Harada K, Nishimura S, Onda J, Nishi T, et al. Chronic subdural hematoma associated with arachnoid cyst. Two case histories with pathological observations. Neurol Med Chir (Tokyo). 2012; 52: 113-117.PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22362297
Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery. 1997; 40: 483-490. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9055286
Kusuno K, Yoshida Y, Takahashi A, Ishii S. Chronic subdural hygroma caused by rupture of arachnoid cyst. As a probable course of chronic subdural hematoma-case report. Neurol Med Chir (Tokyo). 1984 ; 24: 349-354. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6206419
Shim YS, Park CO, Hyun DK, Park HC, Yoon SH. What are the causative factors for a slow, progressive enlargement of a chronic subdural hematoma? Yonsei Med J. 2007; 30; 48: 210-217. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17461518
Haines DE, Harkey HL, Al-Mefty O. The “subdural” space: a new look at an outdated concept. Neuurosurgery. 1993; 32:111-120. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8421539
Zuckerman SL, Prather CT, Yengo-Kahn AM, Solomon GS, et al. Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis. Neurosurg Focus. 2016; 40: E9. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27032926
Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma. 2002; 19:1017-1027. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12482115
Müslüman AM, Özöner B, Kirçelli A, Can SM, Yilmaz A, et al. Chronic subdural hematoma associated with arachnoid cyst of the middle fossa : Surgical treatment and mid-term results in fifteen patients. Turk Neurosurg. 2018; 28: 776-782. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29131236
Aoki N, Sakai T. Intraoperative subdural hematoma in a patient with arachnoid cyst in the middle cranial fossa. Childs Nerv Syst. 1990; 6: 44-46. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2311116
Servadei F, Vergoni G, Frattarelli M, Pasini A, Arista A, et al. Arachnoid cyst of middle cranial fossa and ipsilateral subdural haematoma: diagnostic and therapeutic implications in three cases. Br J Neurosurg. 1993; 7: 249-253. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8338645