The Journal of Emergency Medicine, Vol. 48, No. 5, pp. e121–e122, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter

http://dx.doi.org/10.1016/j.jemermed.2014.12.042

Visual Diagnosis in Emergency Medicine

POST-TRAUMATIC LEPTOMENINGEAL CYST IN A CHILD: COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FINDINGS Ibrahim Guler, MD, Meral Buyukterzi, MD, Ozgur Oner, MD, and Ismet Tolu, MD Department of Radiology, Konya Research and Education Hospital, Konya, Turkey Reprint Address: Ibrahim Guler, MD, Department of Radiology, Konya Research and Education Hospital, Konya 42090, Turkey

mostly arise in the cranial convexity, but cases occurring in the orbital roof and the posterior fossa have also been reported (3,4). Development of a post-traumatic leptomeningeal cyst can take anywhere from several weeks to several years to occur after the trauma (5). Dural laceration that accompanies the skull fracture is the mechanism of this complication. Laceration of dura mater leads to herniation of the leptomeninges, which in turn fills with CSF. The continuous pulsatile pressure of CSF and the enlargement of the cyst result in resorption of adjacent bone, erosion of the bone edges, and widening of the skull fracture (5,6). In radiography, the fracture zone that accompanies the soft-tissue thickness can be seen. CT and MRI are other modalities used in the diagnosis. CT scans are especially useful in detecting the bone fractures. MRI is useful for distinguishing leptomeningeal cysts from other pathologies. The leptomeningeal cysts are isointense to CSF on both T1-weighted and T2-weighted MRI. The associated pathologies, such as encephalomalacia, subdural fluid collection, hematomas, and ventricular dilatation, can also be seen on CT and MRI. Due to the risk of neurologic deterioration and development of a seizure disorder, early diagnosis is important. The standard treatment involves repair of the dura and cranioplasty.

INTRODUCTION Post-traumatic leptomeningeal cysts are a rare complication of cranial fractures in children. In the literature, the incidence of the disease is reported to range from 0.05% to 0.1% (1,2). It is usually seen in children who are younger than 3 years old (2). CASE REPORT A 3-month-old male infant presented with growing scalp swelling. The growing soft mass was located on the posterior vertex of his head. The swelling was compressible but not tender. Physical examination was normal. There was no neurologic deficit. His health history indicated that he had fallen when he was 1 month old. There was a linear fracture in the occipital bone (Figure 1A) and a cystic lesion was detected on computed tomography (CT) (Figure 1B). The lesion was isointense to cerebrospinal fluid (CSF) in all sequences at magnetic resonance imaging (MRI) (Figure 1C and 1D). DISCUSSION Post-traumatic leptomeningeal cysts usually occur after head trauma during the first 3 years of life. It was first reported by John Howship in 1876 (3). These types of cysts

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Figure 1. A linear fracture in occipital bone near the vertex region (A) and a cystic lesion (B) was seen on computed tomography (arrows). The lesion was isointense to cerebrospinal fluid on T2-weighted (C) and fluid attenuation inversion recovery (D) sequences (arrows).

In conclusion, post-traumatic leptomeningeal cysts are rare but they should be considered when there is a pediatric skull fracture. Radiologic modalities have high accuracy and should be used in such patients. REFERENCES 1. Saito A, Sugawara T, Akamatsu Y, Mikawa S, Seki H. Adult traumatic leptomeningeal cyst: case report. Neurol Med Chir (Tokyo) 2009;49:62–5.

2. Hamamcioglu MK, Hicdonmez T, Kilincer C, Cobanoglu S. Large intradiploic growing skull fracture of the posterior fossa. Pediatr Radiol 2006;36:68–70. 3. Gupta SK, Reddy NM, Khosla VK, et al. Growing skull fractures: a clinical study of 41 patients. Acta Neurochir (Wien) 1997;139:928–32. 4. Mohindra S, Mukherjee KK, Chhabra R, Gupta R. Orbital roof growing fractures: a report of four cases and literature review. Br J Neurosurg 2006;20:420–3. 5. Kim H, Jo KW. Treatment of a traumatic leptomeningeal cyst in an adult with fibrinogen-based collagen. J Korean Neurosurg Soc 2013;53:300–2. 6. Khandelwal S, Sharma GL, Gopal S, Sakhi P. Growing skull fractures/leptomeningeal cyst. Indian J Radiol Imaging 2002;12:484–6.

Post-traumatic leptomeningeal cyst in a child: computed tomography and magnetic resonance imaging findings.

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