Although many arachnoid cysts are discovered incidentally and require no intervention, a small subset has been known to rupture. Note that rupture can occur either spontaneously or in association with trauma. Based on a review of the literature on ruptured arachnoid cysts, it appears that patients with middle fossa cysts are more likely to experience symptomatic traumatic rupture than those with cysts in other locations. Middle fossa cysts are more commonly associated with hemispheric subdural collections and hematomas than are any other cysts. The authors report on two representative cases illustrating the distinct presentation, imaging characteristics, and management of these cysts.