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[Chronic subdural hematoma following advanced cancer: report of three cases]
1Department of Neurosurgery, University of Ryukyus, School of Medicine, Okinawa, Japan.
Insights
Advanced cancer patients developed chronic subdural hematoma (CSH). These cases highlight CSH as a rare complication in advanced cancer, often associated with bleeding issues and poor prognosis.
Area of Science:
- Neurosurgery
- Oncology
- Hematology
Background:
- Chronic subdural hematoma (CSH) is a serious condition that can occur in patients with advanced cancer.
- The relationship between advanced malignancy and CSH is not well-established, necessitating further investigation.
Observation:
- Three cases of CSH in patients with advanced cancer are presented, including metastatic adenocarcinoma and gastric cancer.
- Patients presented with neurological deficits, including semicomatose and comatose states, requiring surgical evacuation of CSH.
- Complications such as re-hemorrhage, disseminated intravascular coagulation (DIC), thrombocytopenia, and metastatic spread were observed.
Findings:
- CSH can be a rare but significant complication in advanced cancer patients.
- Hematological abnormalities like DIC and thrombocytopenia are frequently associated with CSH in this population.
- Metastatic cancer involvement of the dura mater was confirmed in one case, suggesting a potential link between malignancy and CSH formation.
Implications:
- These findings underscore the importance of considering CSH in the differential diagnosis of neurological symptoms in advanced cancer patients.
- Early recognition and management of CSH, along with addressing underlying hematological issues, may be crucial for patient outcomes.
- Further research is warranted to elucidate the mechanisms linking advanced cancer to CSH and to optimize treatment strategies.
Abstract:
Three cases of chronic subdural hematoma (CSH) following advanced cancer are reported. Case 1. A 54-year-old male patient was referred to our clinic in a semicomatose state. Bilateral CSH was evacuated through a pair of burr holes, and consciousness was recovered. However, subependymal hemorrhage occurred at the third ventricle 6 days after the operation. Hematological examination revealed thrombocytopenia. He died 12 days after operation because of hemorrhage in the lung. Postmortem examination disclosed metastatic adenocarcinoma of unknown origin to the dura mater, lymph nodes, lung and bone marrow. Case 2. A 50-year-old male patient who was diagnosed as having gastric cancer was referred to our clinic in a state of deep coma. CT scan revealed CSH and putaminal hemorrhage at the left side. Hematological examination revealed disseminated intravascular coagulation (DIC). After the subdural hematoma was evacuated, the putaminal hematoma enlarged and hemorrhagic infarction at the left temporo-occipital lobes occurred. He died 2 days after operation. Autopsy was not carried out, but histological examination revealed poorly differentiated malignant cells in the outer membrane of the subdural hematoma. Case 3. A 53-year-old female patient who had a history of gastric cancer operated on 4 years ago was admitted to our clinic complaining of headache and vomiting. CT scan revealed bilateral subdural hematoma. Following a pair of burr-holes and irrigation of the hematoma, hemorrhage recurred alternatively at the left side on the 6th and at the right side on the 27th day after the operation. Hematological examination revealed DIC, and bone marrow puncture disclosed metastasis of the adenocarcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)