Conservative management of a large temporal epidural hematoma associated with an incidental middle cranial fossa arachnoid cyst: A case report

Background: Epidural hematoma (EDH) is a potentially life-threatening complication of traumatic brain injury typically associated with skull fractures and injury to meningeal vessels. Arachnoid cysts are benign cerebrospinal fluid-filled lesions most frequently located in the middle cranial fossa and are usually discovered incidentally during neuroimaging. The coexistence of an EDH with an underlying arachnoid cyst is uncommon and may influence both the radiological appearance and clinical course. Case Description: A 27-year-old male football player presented with headache and dizziness after a head-to-head collision during a football match. Neurological examination was normal with a Glasgow Coma Scale score of 15. Computed tomography revealed a right temporal EDH measuring approximately 3 cm in thickness without skull fracture. An incidental middle cranial fossa arachnoid cyst was identified in the same region. Despite the relatively large hematoma size, minimal midline shift was observed. The patient remained neurologically stable and was managed conservatively with close clinical and radiological monitoring. Follow-up imaging demonstrated stabilization of the hematoma. Conclusion: The presence of an arachnoid cyst may provide additional intracranial space that partially accommodates traumatic hemorrhage, potentially allowing conservative management in carefully selected cases.