Clinical investigation of chronic subdural hematoma with impending brain herniation on arrival

Calcified chronic subdural hematoma (CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas (CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache, decreased alertness, weakness, numbness, gait disturbance, seizures, memory impairment, confusion, and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report, we present the case of a patient with CCSDH who developed severe cerebral edema following its removal, necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests, and no signs of brain herniation or epilepsy was found the following day after surgery, the patient's family refused all treatment and a postoperative brain computed tomography (CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough (NPPB) may cause severe cerebral edema following the total removal of a CCSDH.

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Current Clinical Standards for the Treatment of Chronic Subdural Hematoma in Austrian, German, and Swiss Neurosurgical Units

10.1055/s-0038-1660763 ◽

2018 ◽

Author(s):

D. Baschera ◽

L. Tosic ◽

L. Westermann ◽

J. Oberle ◽

A. Alfieri

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Clinical Standards

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Bilateral Acute Subdural Hematoma Following Evacuation of Chronic Subdural Hematoma

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2007.41.4.267 ◽

2007 ◽

Vol 41 (4) ◽

pp. 267 ◽

Cited By ~ 4

Author(s):

Seok Won Kim ◽

Seung Myung Lee ◽

Ho Shin

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Acute Subdural Hematoma

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Independent predictors for functional outcome after drainage of chronic subdural hematoma identified using a logistic regression model

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.17.04056-5 ◽

2020 ◽

Vol 64 (2) ◽

Cited By ~ 2

Author(s):

Sotirios Katsigiannis ◽

Christina Hamisch ◽

Boris Krischek ◽

Marco Timmer ◽

Anastasios Mpotsaris ◽

...

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Functional Outcome ◽

Subdural Hematoma ◽

Logistic Regression Model ◽

Chronic Subdural Hematoma

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Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic Subdural Hematoma: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1713092 ◽

2021 ◽

Author(s):

Tiago Silva Holanda Ferreira ◽

Gilnard Caminha de Menezes Aguiar ◽

Daniel Gurgel Fernandes Távora ◽

Lucas Alverne Freitas de Albuquerque ◽

Stélio da Conceição Araújo Filho

Keyword(s):

Case Report ◽

Subdural Hematoma ◽

Specific Antigen ◽

Chronic Subdural Hematoma ◽

Radical Resection ◽

Prostate Adenocarcinoma ◽

Meningeal Carcinomatosis ◽

Motor Deficits ◽

Friable Material ◽

The Central Nervous System

Abstract Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies.Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy.Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection.At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other key markers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma. Discussion Meningeal carcinomatosis presents clinically with headache, motor deficits, vomiting, changes in consciousness and seizures.The two most discussed mechanisms of neoplastic infiltration are the hematogenous route and retrograde drainage by the vertebral venous plexus. Conclusion Variable clinical presentations may occur in dural metastases; however, the radiological presentation as subdural hematoma is rare. There are few descriptions of cases like this one in the literature.To support the diagnosis, the previous medical history is as important as the complementary exams and the radiological findings, because the symptoms are common at the neurological emergency. To our knowledge, this is the first report of a prostate neoplasm mimicking chronic subdural hematoma in Brazil.

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