Acute Subdural Hemorrhage Associated With Both Metastatic Adenocarcinoma of the Dura and Minor Head Trauma: A Case Report and Review of the Literature.

Abstract

While reportedly a relatively common finding at the autopsy of decedents with metastatic neoplasms, dural metastases are infrequently described in the medical literature and only 55 cases of subdural hemorrhage associated with dural metastases have been described, with only one of these cases associated with head trauma. We report a 50-year-old incarcerated male who died as the result of acute and chronic subdural hemorrhage associated with recent minor head trauma and dural metastases, which were most likely of pancreatic origin. He had sustained a fall, possibly due to a seizure in his jail cell, developed an acute subdural hemorrhage, and died, necessitating an autopsy. Metastatic tumor in the dura and other organs was identified upon histologic examination and found to be CK7 and CK20 positive and TTF-1 and CDX2 negative, consistent with a pancreatic adenocarcinoma. In addition, marantic endocarditis was identified, which can occur in individuals with mucinous tumors, such as a pancreatic neoplasm. This case report offers the second description of a subdural hemorrhage occurring in association with both dural metastases and recent head trauma and confirms the importance of histologic examination of the subdural hemorrhage and adjacent dura at autopsy for reasons other than just timing of the event.