Subdural Metastasis of Prostate Cancer

Abstract

Dural metastasis from prostate cancer is rare and may mimic a subdural hematoma (SDH). Preoperatively diagnosis may be difficult and only reveal its presence during surgery. We present such a case and review the literature to identify common characteristics. A 65-year-old man presented with headache, confusion, and progressive right upper limb weakness. Past history included a prostate adenocarcinoma with bone metastasis 3 years earlier. Head computed tomography (CT) scan without contrast revealed a multinodular bilateral hyperdense extra-axial lesion interpreted as acute SDH. At surgery planned for SDH drainage no blood was found; instead there was an en plaque subdural yellowish tumor. Histopathologic examination was consistent with metastatic adenocarcinoma of the prostate. We found 11 cases reported as dural metastasis of prostate cancer mimicking SDH. Surgery was performed on nine cases with no suspicion of dural metastasis. On preoperative nonenhanced CT scan images, three types of image patterns can be described: a nodule in SDH, multinodular metastasis surrounded by SDH, and large en plaque subdural tumor. The latter group consists of those cases where no blood but rather an en plaque subdural tumor was found at surgery. Even though rare, dural metastasis should be considered among the differential diagnoses in a patient known for prostate cancer.

Widespread subdural metastasis from breast cancer progressing rapidly with cerebral herniation: A case report

“…In cases of extensive en plaque subdural tumors, where unexpectedly no blood was found, a larger craniotomy revealed an extensive tumor not amenable to surgical treatment (9). The characteristics of our case conformed to the latter type, namely a large en plaque subdural tumor.…”

“…Nzokou et al identified three image patterns in dural metastasis: i) A nodule in a subdural hematoma, ii) multinodular metastasis surrounded by a subdural hematoma and iii) an extensive en plaque subdural tumor (9). In cases of extensive en plaque subdural tumors, where unexpectedly no blood was found, a larger craniotomy revealed an extensive tumor not amenable to surgical treatment (9).…”

“…The operative method appropriate for metastatic subdural tumor with midline shift may differ completely from that for chronic subdural hematoma. In cases of en plaque subdural tumors, the preoperatively planned burr hole or craniotomy must be converted into a larger craniotomy (9). If preoperative diagnosis is difficult, the operative procedures must be adjusted.…”

An Unexpected Subdural Collection: Story of a Prostatic Metastasis

“…Subdural metastasis of prostate cancer can mimic a chronic subdural hematoma (30%), an acute hematoma (23%), or, more often, a mixed or subacute subdural hematoma. [5][6][7][8][9][10][11][12][13][14][15] In 38% of patients, subdural metastasis of prostate cancer is associated with a real subdural chronic hematoma. In such cases, images do not show blood sedimentation as in usual mixed hematoma, but a nonenhanced hyperdensity attached on dura.…”

“…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.…”