Subdural hematoma from metastatic malignant disease

Abstract

An unusual complication of cancer metastasis to the central nervous system is subdural hematoma due to obstruction of dural vessels by tumor cells. Such a case is presented to call attention to this rare but treatable entity which should be included in the differential diagnosis in any cancer patient with unexplained neurologic signs or fluctuations in state of consciousness.

Subdural hematoma associated with disseminated intravascular coagulation in patients with advanced cancer

“…The formation of the hematoma neomembrane was regarded as a consequence of dilatation, engorgement, and rupture of the capillaries of the areolar layer. Braun, et al, 3 and Leech, et al, 4 supported this explanation based on their observations in dura specimens, which evidenced emboli of tumor cells within the dilated dural vessels. A similar finding was recognized in Case 4 under microscopic study.…”

“…Since then, Wohlwill, 12 Russell and Cairns, 9 and Meyer and Reah 5 have reported similar cases, using the same term. In the past decade, Braun, et al, 3 Leech,et al,4 Ambiavagar and Sher, 2 and Ng Tang Fui, et al, 7 have described some similar cases as subdural hematoma.…”

“…ONTRAUMATIC subdural hematoma is found only rarely in patients with advanced cancer. [2][3][4][5]7,9,11,12 So far, it has been assumed that this type of hematoma is a result of obstruction of the dural veins by tumor cells. 2-4, 9 We have recently encountered four cases of subdural hematoma, which seemed to be secondary to disseminated intravascular coagulation (DIC) due to advanced cancer.…”

Acute aggravation of subdural fluid collection associated with dural metastasis of malignant neoplasms: case report and review of the literature

“…It is expected, therefore, that the effect of surgical management of such cases may not result in improvement. On the other hand, aggressive surgical treatments can achieve a favorable outcome in some cases [ 3 – 5 , 7 , 10 , 25 ], so that the therapeutic approach employed should be chosen according to the individual condition of each patient. When the overall status of the patient is poor, insertion of an Ommaya reservoir may be effective [ 11 , 13 ]; postoperative irradiation appears to be necessary to control the residual tumor [ 2 , 11 , 17 ].…”

Prostate carcinoma presenting as intracranial hemorrhage

“…4,~1,26 A majority (Table 2 ). 1,3,5,[13][14][15]17,19,21,24,27,28 Again, the majority of these have been autopsy findings, with the h e m a t o m a varying from acute to chronic. In some cases, there had been evidence of direct cancerous invasion of the subdural space from the scalp or skull.…”