VOL. 526, No. 3 629 INTRA- AND EXTRACEREBRAL ARACHNOID CYST* ABSTRACT: AN ATYPICAL ROENTGENOGRAPHIC PRESENTATION By RICHARD E. LATCHAW, MAJOR, USAF, MC,t and JOSEPH NADELL, MAJOR, USAF, MC TRAVIS AIR FORCE BASE, CALIFORNIA Arachnoid cysts present in a variety of ways, and the preoperative diagnosis usually requires a high degree of suspicion. Bony changes consistent with a chronic focal mass effect, a relative paucity of clinical findings compared to the size of the lesion, and an extracemebmal mass with an intracerebmal component suggest the possibility. We present a case in which there appears to be a large, deep intra- cerebral mass associated with an extracerebral expansion. RACHNOID cysts are uncommon but by no means rare intracranial lesions. Their presentation can vary from that of a progressive neurological defect6 to an mci- dental finding at the time of autopsy.’4”6’2#{176} Roentgenognaphically, they may mimic other conditions, particularly an extra- cerebral expansion such as subdural hema- toma.”12 Rarely, the roentgenographic ap- peanance may suggest the presence of a superficial intmacerebnal mass.’2 The follow- ing case of an amachnoid cyst presents an unusual roentgenographic appearance in that there appears to be a large, deep intra- cerebral mass associated with an extracere- brat expansion. REPORT OF A CASE R.M., a 23 year old airman, was in good health until November 25, 1974, when he had a grand mal seizure. He was evaluated at a local Air Force hospital and found to be neurologically intact. However, routine skull roentgenograms revealed an abnormality of the sella turcica, and the patient was transferred to David Grant Medical Center (DGMC), Travis Air Force Base, California, for further evalu- ation. During neurosurgical consultation at DGMC, the patient admitted having transient episodes of “blurry vision” lasting ten to fifteen seconds occurring weekly for the preceding six months, and a steady frontal headache for two weeks prior to the seizure. Review of his past medical history revealed that at age five he had fallen on a piece of barbed wire that had entered his right orbit. There had been no initial loss of consciousness, but within twelve hours he was obtunded and febrile. He was referred to the Mayo Clinic where ophthalmologic exami- nation revealed ecchymosis of the entire right upper lid and an edematous area near the trochlea that was felt to be the site of puncture. Skull roentgenograms were normal. On lumbar puncture there was an opening pressure of 360 mm H20. Cell count on the cerebrospinal fluid (CSF) showed 57 lymphocytes, 3,328 polymorphonuclear leukocytes, and 20,000 red blood cells per cubic millimeter. The spinal fluid protein was 200 mgm percent and glucose was 300 mgm percent. No bacteria were seen on smear and cultures were subsequently sterile. In view of the rapid onset of symptoms and the abnormal CSF findings, the patient was treated for meningitis with parenteral and oral anti- biotics for fourteen days. His recovery was un- eventful and he had no further central nervous system symptoms until his grand mal seizure. General physical and neurological examina- tions at DGMC were entirely normal. Opening pressure on lumbar puncture was 280 mm H20. CSF analysis revealed two lymphocytes per cubic millimeter, a protein of 37 mgm percent, and glucose of 8 mgm percent. Electroen- cephalography demonstrated two to three cycle per second delta activity in the left frontal and a From the Departments of Radiologyt and Neurosurgery4 David Grant USAF Medical Center, Travis Air Force Base, California. t Present Address: Department ofRadiology, University ofMinnesota Hospital, Minneapolis, Minnesota. Present Address: Suite 300, 7I4 Canal Street, New Orleans, Louisiana. The views expressed herein are those of the authors and not necessarily those of the Department of Defense or the United States Air Force. Downloaded from www.ajronline.org by 171.243.65.178 on 05/21/23 from IP address 171.243.65.178. Copyright ARRS. For personal use only; all rights reserved
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