- Email: [email protected]
Hemispheric Chronic Subdural Hematoma Concealing Subdural Metastases: Terrible Surprise Behind Routine Emergency Department Consultation
Accepted Manuscript A Hemispheric Chronic Subdural Hematoma concealing Subdural Metastases. A Terrible Surprise behind a routine Emergency Room consultation Riccardo Caruso, MD, Associate Professor, Alessandro Pesce, MD, Valentina Martines, MD PII:
S1878-8750(17)31159-2
DOI:
10.1016/j.wneu.2017.07.059
Reference:
WNEU 6121
To appear in:
World Neurosurgery
Received Date: 12 May 2017 Revised Date:
9 July 2017
Accepted Date: 11 July 2017
Please cite this article as: Caruso R, Pesce A, Martines V, A Hemispheric Chronic Subdural Hematoma concealing Subdural Metastases. A Terrible Surprise behind a routine Emergency Room consultation, World Neurosurgery (2017), doi: 10.1016/j.wneu.2017.07.059. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Caruso
ACCEPTED MANUSCRIPT Clinical Images
A Hemispheric Chronic Subdural Hematoma concealing Subdural Metastases. A Terrible
RI PT
Surprise behind a routine Emergency Room consultation. Short Title: Subdural Metastases mimicking a Hemispheric Chronic Subdural Hematoma.
Riccardo Caruso 1 – MD, Associate Professor
SC
Alessandro Pesce 2 – MD
M AN U
Valentina Martines 3 – MD
EP
TE D
1 Neurology and Psichiatry Department – Neurosurgery Division - “Sapienza” University, Roma, Italy, Viale del Policlinico 155, 00161, Roma. 2 NESMOS Department Neurosurgery Department “Sapienza” University, Roma, Italy, Via di Grottarossa 1039, 00189, Roma 3 Neuroradiology Division – Policlinico Umberto I - “Sapienza” University, Roma, Italy, Viale del Policlinico 155, 00161, Roma.
The authors certify that they have NO affiliations with or involvement in any organization or entity
AC C
with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors confirm their adherence to ethical standards and have NO financial disclosures that would be a potential conflict of interest with this publication.
Corresponding Author: Dr. Alessandro Pesce Email: [email protected]
Azienda Ospedaliera Sant’Andrea, Roma, Italy
Caruso
ACCEPTED MANUSCRIPT Via di Grottarossa, 1035 – 1039, 00189, Roma – Italy Phone number: +393471094244; Fax number: +390633775324
RI PT
Text The patient is a 79 years old male suffering from advanced metastatic prostate cancer. He presented progressively worsening cognitive-motor slowing and was therefore referred to the Emergency
SC
Room of our facility. A plain axial CT scan (A,B) revealed a vast hemispheric subdural fluid collection that seemed to be a subdural hematoma. At closer inspection, and more importantly, in
M AN U
hindsight, it would have been possible to also detect a tenuously iso-hyperdense signal irregularity at the frontal aspect of the fluid collection (*). Because of the poor general medical conditions of the patient and because of the paucity of the neurological impairment, a high-dose corticosteroidbased conservative strategy was implemented. The Total body CT scan for the routine oncological
TE D
follow-up concerning the prostate cancer took place 20 days after the first CT scan at the Emergency Room. (C) A second contrast enhanced axial CT scan showed the presence of two dural metastases, which the initial pathogenesis of the subdural fluid collection can presumably be
EP
ascribed to. The pathogenesis of this condition is generally thought to be linked to: 1. hemorrhagic effusion from the metastatic tissue, 2. dural vessel obstruction by tumor neoplastic invasion,
AC C
3. an angio-desmoplastic reaction of the dural sheets to neoplastic infiltration1.
Keywords: Subdural Metastases, CT, Subdural Hematoma, brain metastases, corticosteroids.
References
1. Cheng CL, Greenberg J, Hoover LA. Prostatic adenocarcinoma metastatic to chronic subdural hematoma membranes: case report. J Neurosurg. 1988 Apr;68(4):642-4.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
Caruso
ACCEPTED MANUSCRIPT An Hemispheric Chronic Subdural Hematoma hiding Subdural Metastases. A Bad Surprise behind a routine Emergency Room consultation.
1. Subdural Metastases are a quite uncommon entity
RI PT
Highlights
2. Subdural Metastases may be responsible for subdural fluid collections
SC
3. Not all the chronic subdural hematomas are investigated with contrast medium 4. A correct diagnosis of Subdural Metastases may be impossible with plain CT
AC C
EP
TE D
M AN U
5. An MR or contrast enhanced CT scan may be performed in oncological patients
ACCEPTED MANUSCRIPT Caruso
An Hemispheric Chronic Subdural Hematoma hiding Subdural Metastases. A Bad Surprise
RI PT
behind a routine Emergency Room consultation.
Abbreviations
AC C
EP
TE D
M AN U
SC
CT: Computed Tomography
S1878-8750(17)31159-2
DOI:
10.1016/j.wneu.2017.07.059
Reference:
WNEU 6121
To appear in:
World Neurosurgery
Received Date: 12 May 2017 Revised Date:
9 July 2017
Accepted Date: 11 July 2017
Please cite this article as: Caruso R, Pesce A, Martines V, A Hemispheric Chronic Subdural Hematoma concealing Subdural Metastases. A Terrible Surprise behind a routine Emergency Room consultation, World Neurosurgery (2017), doi: 10.1016/j.wneu.2017.07.059. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Caruso
ACCEPTED MANUSCRIPT Clinical Images
A Hemispheric Chronic Subdural Hematoma concealing Subdural Metastases. A Terrible
RI PT
Surprise behind a routine Emergency Room consultation. Short Title: Subdural Metastases mimicking a Hemispheric Chronic Subdural Hematoma.
Riccardo Caruso 1 – MD, Associate Professor
SC
Alessandro Pesce 2 – MD
M AN U
Valentina Martines 3 – MD
EP
TE D
1 Neurology and Psichiatry Department – Neurosurgery Division - “Sapienza” University, Roma, Italy, Viale del Policlinico 155, 00161, Roma. 2 NESMOS Department Neurosurgery Department “Sapienza” University, Roma, Italy, Via di Grottarossa 1039, 00189, Roma 3 Neuroradiology Division – Policlinico Umberto I - “Sapienza” University, Roma, Italy, Viale del Policlinico 155, 00161, Roma.
The authors certify that they have NO affiliations with or involvement in any organization or entity
AC C
with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors confirm their adherence to ethical standards and have NO financial disclosures that would be a potential conflict of interest with this publication.
Corresponding Author: Dr. Alessandro Pesce Email: [email protected]
Azienda Ospedaliera Sant’Andrea, Roma, Italy
Caruso
ACCEPTED MANUSCRIPT Via di Grottarossa, 1035 – 1039, 00189, Roma – Italy Phone number: +393471094244; Fax number: +390633775324
RI PT
Text The patient is a 79 years old male suffering from advanced metastatic prostate cancer. He presented progressively worsening cognitive-motor slowing and was therefore referred to the Emergency
SC
Room of our facility. A plain axial CT scan (A,B) revealed a vast hemispheric subdural fluid collection that seemed to be a subdural hematoma. At closer inspection, and more importantly, in
M AN U
hindsight, it would have been possible to also detect a tenuously iso-hyperdense signal irregularity at the frontal aspect of the fluid collection (*). Because of the poor general medical conditions of the patient and because of the paucity of the neurological impairment, a high-dose corticosteroidbased conservative strategy was implemented. The Total body CT scan for the routine oncological
TE D
follow-up concerning the prostate cancer took place 20 days after the first CT scan at the Emergency Room. (C) A second contrast enhanced axial CT scan showed the presence of two dural metastases, which the initial pathogenesis of the subdural fluid collection can presumably be
EP
ascribed to. The pathogenesis of this condition is generally thought to be linked to: 1. hemorrhagic effusion from the metastatic tissue, 2. dural vessel obstruction by tumor neoplastic invasion,
AC C
3. an angio-desmoplastic reaction of the dural sheets to neoplastic infiltration1.
Keywords: Subdural Metastases, CT, Subdural Hematoma, brain metastases, corticosteroids.
References
1. Cheng CL, Greenberg J, Hoover LA. Prostatic adenocarcinoma metastatic to chronic subdural hematoma membranes: case report. J Neurosurg. 1988 Apr;68(4):642-4.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
Caruso
ACCEPTED MANUSCRIPT An Hemispheric Chronic Subdural Hematoma hiding Subdural Metastases. A Bad Surprise behind a routine Emergency Room consultation.
1. Subdural Metastases are a quite uncommon entity
RI PT
Highlights
2. Subdural Metastases may be responsible for subdural fluid collections
SC
3. Not all the chronic subdural hematomas are investigated with contrast medium 4. A correct diagnosis of Subdural Metastases may be impossible with plain CT
AC C
EP
TE D
M AN U
5. An MR or contrast enhanced CT scan may be performed in oncological patients
ACCEPTED MANUSCRIPT Caruso
An Hemispheric Chronic Subdural Hematoma hiding Subdural Metastases. A Bad Surprise
RI PT
behind a routine Emergency Room consultation.
Abbreviations
AC C
EP
TE D
M AN U
SC
CT: Computed Tomography