Arachnoid cysts are benign, congenital, and intra arachnoidal lesions. Most of the clinically active cysts present seizures due to chronic compression. Presentation as spontaneous cyst subdural hygroma is a rare clinical entity. We present a case of arachnoid cyst subdural hygroma. In a case, a 25 years male without any prior history of neurological deficit is presented to emergency with a complaint of headache for two weeks. Examination showed consciousness fully with positive Cushing's reflex. MR imaging of the brain showed the left temporal extra-axial cystic lesion, suggestive of the arachnoid cyst with the subdural fluid collection, extending along the frontotemporal-parietal lobes and the left Sylvian fissure. Partially the cyst was drained through left temporal craniectomy, and subdural hygromas were drained. The left subdural peritoneal shunt was placed to prevent future subdural fluid collections. The patient was recovered uneventfully and discharged on the eighth day postoperative.
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