Bilateral frontal arachnoid cyst rupture associated with chronic subdural hematoma following traumatic brain injury: a case report and literature review

Introduction: Chronic subdural hematoma (CSDH) and arachnoid cyst (AC) are distinct intracranial entities that may coexist, particularly following trauma. Although ACs are generally benign, their rupture can result in significant complications, including hemorrhage. Presentation of case: A 52-year-old male with bilateral frontal ACs and a history of epilepsy sustained a traumatic brain injury from a road traffic accident. One month later, he developed a severe headache, drowsiness, and syncope. Brain CT revealed bilateral CSDH secondary to cyst rupture. The patient underwent unilateral burr hole drainage, achieving complete hematoma evacuation and full neurological recovery. Follow-up MRI at 6 months showed no recurrence. Discussion: The association between AC rupture and CSDH likely involves trauma-induced tearing of bridging veins or cyst membranes. Early surgical management via burr hole drainage is typically curative, while craniotomy is reserved for refractory cases. Conclusion: Prompt recognition and minimally invasive treatment yield excellent outcomes in traumatic AC rupture with CSDH, though further studies are required to conclusively document these therapeutic outcomes in complex bilateral cases.