Holohemispheric Prostate Carcinoma Dural Metastasis Mimicking Subdural Hematoma: Case Report and Review of the Literature

Abstract

Prostate carcinomas are the most common malignancy to metastasize to the dura. These metastases can commonly mimic subdural hematomas and may similarly present with brain compression. The optimal management and outcomes after surgical management are not well characterized. We present a case of prostate carcinoma metastatic to the dura that was initially thought to be a large isodense subdural hematoma and was treated with surgical decompression. We also review the literature regarding prostate dural metastases mimicking subdural hematomas and discuss the relevant imaging findings, treatments, and outcomes. Dural metastasis should be considered when a patient with known metastatic prostate cancer presents with imaging evidence of a subdural mass.

Brain metastases as the first clinical manifestation of prostate cancer: a case report

“…Отдаленные метастазы развиваются приблизительно у 17% больных РПЖ. Наиболее распространенными местами их локализации являются кости осевого (череп, позвонки, ребра) и добавочного скелета (таз, нижние конечности) -90%, лимфатические узлы -10,6%, печень -10,2%, легкие -9,1% [10][11][12].…”

Incidental finding of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma: A case report and review of literature

“…However, the following three mechanisms of brain metastasis are widely recognized [6] : the tumor embolism passes through a patent foramen ovale, thus bypassing the lung; Cancer cells enter the pulmonary capillaries, enter the left atrium, and then spread through the arterial blood; Secondary spreading from pulmonary metastasis. Prostate cancer most commonly spreads to the bones, including the pelvis, vertebra, ribs, femur, and skull [7] . Cranial nerve palsy is caused by extensive invasion of the skull base [5] .…”

Leptomeningeal Metastatic Prostate Cancer Imitating a Subdural Hematoma

“…Direct hematogenous spread, extension from bony skull metastases to the leptomeninges, and, in rare cases, dissemination from cerebral metastases are the mechanisms of metastatic spread. Clinically, patients present with non-specific symptoms such as headache and/or altered mental status [ 6 ]. In addition, leptomeningeal metastases, or carcinomatous meningitis, are a rare complication of advanced cancer from solid tumors, most commonly breast cancer (16%), lung cancer (10%-26%), and melanoma (5%-25%).…”

“…In our patient, with a history of falls and head trauma, the presence of dural metastases was suspected on brain MRI and later confirmed following surgical resection and histopathologic examination of the resected tissue. Brain MRI with gadolinium infusion is a much more sensitive diagnostic tool for the diagnosis of dural lesions and provides significant data regarding the lesion's morphology, its dimensions and extent of growth, and its resectability [ 6 ]. The advent of new techniques such as magnetic resonance spectroscopy (MRS) may improve diagnostic capabilities.…”

“…Ultimately, diagnosis is established and confirmed by histological examination of the resected tissue. The median survival from the diagnosis of dural metastases was three to four months [ 6 ].…”