Prostate dural metastasis presenting as chronic subdural hematoma. A case report and review of the literature.

Alexandros Boukas,Nicholas Ross,Geraintj Sunderland

doi:10.4103/2152-7806.151713

Abstract

Background:Malignant disease metastasising to the cranial dura is rare. Dural metastases manifesting as a subdural fluid collection and presenting as a chronic subdural hematoma is an uncommon entity with unknown pathophysiology.Case Description:We present a patient with known prostate cancer metastasising to the cranial dura masquerading as a chronic subdural hematoma. The patient presented with bilateral subdural collections manifesting with confusion and dysphasia. Initial drainage of the larger, symptomatic left side improved only temporarily patient's symptoms. A second drainage of the collection was performed on the same side 5 days later and dural biopsies taken during the same procedure revealed prostate metastases. The patient improved slowly and was discharged to a hospice for palliative care management.Conclusions:Prostate dural metastases should be suspected in patients with known prostate cancer presenting with a subdural collection in the absence of cranial trauma. If decision to drain the subdural collection is taken, then biopsies can be taken the same time as they can pose a diagnostic challenge.

Highlights

Malignant disease metastasising to the cranial dura is rare
Prostate adenocarcinoma is the most common cancer in men, approximately 40,000 cases are diagnosed each year in the UK and it accounts for around 7% of all cancer deaths
Grading is done as per the Gleason grading system, which scores the tumor on the basis of biopsy tissue architecture criteria giving a maximum possible score of 10 for the most aggressive and worst prognostic tumors

Summary

Conclusions

Prostate dural metastases should be suspected in patients with known prostate cancer presenting with a subdural collection in the absence of cranial trauma. A 75‐year‐old male was referred to our unit with unsteadiness, falls, and slurred speech His past medical history included a hormone escaped prostate adenocarcinoma with known bony metastases to the ribs and pelvis as well as intrabdominal lymph node involvement. Computed tomography (CT) head performed at the referring hospital revealed bilateral chronic subdural collections, larger on left side, with 18 mm midline shift to the right. These had the typical radiological appearance of liquefied hematomas [Figure 1]. Repeat CT of his head revealed re‐accumulation of the subdural collection, with moderate mass effect [Figure 2] He returned to theatre where again the left sided subdural collection was re‐opened, found to be under high pressure, re‐drained and send for cytology. After a total inpatient stay of 5 weeks, he was discharged to a hospice for palliative care management where he succumbed to his disease one month later

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CONCLUSION