Dural metastases from prostate cancer mimicking acute sub-dural hematoma

Abstract

Metastases of prostate carcinoma to the central nervous system are rare, while dural metastases are even rarer. Patients are often clinically asymptomatic or present with non-specific symptoms, rendering the condition unsuspected. The imaging findings could resemble benign conditions and be misdiagnosed as such when the diagnosis is not considered. We present an unusual case of dural metastasis from carcinoma of the prostate mimicking acute sub-dural hematoma as shown on non-contrast-enhanced CT. The radiological features are analyzed, and clues to differentiating the two conditions are discussed.

Dural Metastases in Advanced Prostate Cancer: A Case Report and Review of the Literature

“…The former has the advantage of detecting bone involvement while the latter provides better contrast resolution and is considered the superior means of detection of dural metastases and delineation of soft tissue involvement [5]. The most frequent finding is a thickening of the dura mater with intense contrast enhancement.…”

“…A nodular pattern is also possible [4]. Dural metastases may also induce a classic subdural hematoma [5]. Differential diagnoses should include meningioma, and lymphoma [4].…”

Post-traumatic acute-on-chronic subdural haematoma: an unusual presentation of skull metastasis from prostate carcinoma

“…In 2012, Wong-Li Yu et al 5 reported a case of DPM mimicking acute subdural haematoma. In that case, radiological features were more atypical and the patient's stable clinical conditions allowed for time for a full workup (contrast-enhanced CT, then gadolinium-enhanced MRI) and communication with the oncology team following the patient, which also in this case revealed a bone scintigraphy performed several months prior already showing metastatic involvement of the skull vault.…”

An Unexpected Subdural Collection: Story of a Prostatic Metastasis

“…3 Except in 2 (15 %) of the 13 cases (including the present case) reported in the literature, the diagnosis was made during a surgical procedure. In these 2 cases, 7,12 the patients presented an extensive metastatic spreading of prostate cancer and had benefited from an MRI because of uncommon features on head CT scan. MRI showed an extensive and homogenous dural and subdural enhancement involving the contralateral subdural space, as we found on MRI performed in our patient after surgery (Figure 2).…”

“…The most frequent origin is prostate (1/5 cases), 4 and less than 15 observations have been reported. [5][6][7][8][9][10][11][12][13][14][15] These few cases were misdiagnosed because of clinical and radiologic similarity to subdural hematomas. Patients underwent drainage surgery, which is not an appropriate treatment in this case.…”