Abstract
Purpose :
Arachnoid cysts are intra-arachnoidal collections of cerebrospinal fluid, which may be congenital or secondary to head injuries, intracranial hemorrhage, or infection. Occasionally these cysts can rupture spontaneously or secondary to trauma, resulting in subdural hemorrhage or, more rarely, a subdural cerebrospinal fluid collection without hemorrhage. While the neurologic manifestations of ruptured arachnoid cysts have been well described, there is little published data examining the ocular manifestations in the setting of ruptured arachnoid cysts, particularly among patients with associated subdural hemorrhage or fluid collection. By examining the records of pediatric patients with documented radiographic evidence of ruptured arachnoid cysts as well a formal ophthalmologic exam, we sought to better characterize the ocular findings associated with ruptured arachnoid cysts.
Methods :
We performed a retrospective chart review of all patients treated for ruptured arachnoid cysts at Children’s Hospital Colorado from 1 January 2006 to 1 August 2018 and recorded the findings of ophthalmology exams in these patients. Children who did not receive an eye exam during their initial admission were excluded.
Results :
A total of 23 children were treated for ruptured arachnoid cysts at our institution during the study period, 17 of whom were eligible for this study due to receiving an eye exam during their admission. Age at time of rupture ranged from 9 months to 17 years (median age 5 years). Eleven children experienced spontaneous rupture of their arachnoid cyst, while the etiology was traumatic in the remaining six. Subdural hemorrhage or fluid was noted in 16 of the 17 patients on MRI. Funduscopic exams revealed papilledema in 10 patients, but no papilledema was noted in any of the 5 patients under 3 years old. Retinal hemorrhages were found only in the 2 patients who were under 2 years old, with non-accidental trauma highly suspected in one case. Best corrected visual acuity in verbal children ranged from 20/20 to 20/30.
Conclusions :
Children with ruptured arachnoid cysts commonly develop papilledema, though this may be less likely in younger children. Retinal hemorrhages are less likely to develop but may be seen in especially young patients. Ophthalmology should be consulted in all cases of ruptured arachnoid cysts in children due to the likelihood of ocular manifestations, though the visual prognosis is generally good.
This is a 2021 ARVO Annual Meeting abstract.