2024 Volume 47 Issue 1 Pages 22-26
Introduction: Chronic subdural hematoma (CSDH) is commonly seen in elderly individuals. In this report, we present a case of a 25–year–old soccer player with arachnoid cyst who developed CSDH and provide a literature review.
Case: A 25–year–old soccer player was diagnosed with asymptomatic arachnoid cyst since childhood. The patient had occasionally hit the ball while playing soccer, but had no restriction on heading the ball. The patient suffered from headache and vomiting after repeated heading practice. He visited to referring hospital two weeks after the onset of symptoms. Head CT showed left middle fossa arachnoid cyst without hemorrhage and CSDH. Although it became a follow–up observation, his symptoms gradually deteriorated, and he revisited the hospital. Brain MRI revealed CSDH characterized by low signal intensity on T1–weighted and FLAIR images, and high signal intensity on T2–weighted images, located at the left subdural and intracranial compartments. The patient was diagnosed with left CSDH and transferred to our hospital. He underwent emergent burr hole drainage surgery, resulting in a favorable outcome.
Discussion: The presence of arachnoid cyst has been reported as a contributing factor to CSDH in young individuals. Soccer players have potential risks of chronic head impacts through repeated heading, highlighting the importance of awareness and caution. Treatment options for cases involving arachnoid cysts complicated by chronic subdural hematoma include burr hole surgery or craniotomy, but there are no established treatment guidelines. When the arachnoid cyst wall is ruptured and continuous with the hematoma cavity, less invasive burr hole evacuation under local anesthesia is considered preferable. Once chronic subdural hematoma occurs, it can have implications for academic and occupational activities. Arachnoid cysts can contribute to the development of CSDH, emphasizing the need to provide information and raise awareness among soccer players. This case suggests that the occurrence of a chronic subdural hematoma was triggered by the practice of repeated heading a ball strongly kicked.
Conclusion: Soccer players with arachnoid cysts should be prohibited from repeated heading practice.
