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Intracranial multiple myeloma may imitate subdural hemorrhage: How to overcome diagnostic limitations and avoid
Anna Prajsnar-Borak1, Naci Balak2, Harald Von Pein3
1Department of Neurosurgery, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany; Department of Neurosurgery, Universitätsmedizin Mainz, Germany.
Background:
Although the diagnosis of subdural hematoma is usually straightforward, occasionally it may be erroneous, leading to mistakes in the treatment. For example, leptomeningeal malignancies, even in the absence of bleeding, may clinically and radiologically mimic subdural hemorrhage.
Objective:
To stress the importance of not only intuitive thinking but also in analytic thinking in appropriate and accurate treatment strategies.
Methods And Illustrative Case:
In this report, the clinical and radiological pitfalls in differentiating malignant leptomeningeal infiltration and subdural hematomas are discussed. A sample case of an intracranial extra-osseous manifestation of a multiple myeloma that is atypical with regard to its location and clinical presentation is presented for illustration.
Conclusions:
The variability of intracranial presentation and the wide spectrum of leptomeningeal malignancies necessitate careful preoperative evaluation of the patient's individual history as well as radiological images to avoid misdiagnosis. A clinician who has become familiar with the pitfalls in the differential diagnosis between leptomeningeal infiltrations and subdural hematoma will act more analytically to solve the patient's problems properly and avoid potential complications for the patient.
Insights
Accurate diagnosis of subdural hematoma is crucial, as leptomeningeal malignancies can mimic it. Careful preoperative evaluation and analytical thinking prevent misdiagnosis and improve patient outcomes.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Subdural hematoma diagnosis is typically straightforward but can be misdiagnosed.
- Leptomeningeal malignancies can mimic subdural hemorrhage clinically and radiologically, even without bleeding.
Observation:
- This report discusses clinical and radiological challenges in differentiating malignant leptomeningeal infiltration from subdural hematomas.
- An atypical case of intracranial multiple myeloma is presented to illustrate these diagnostic difficulties.
Findings:
- Malignant leptomeningeal infiltration can present with variable intracranial findings.
- Accurate differentiation requires thorough preoperative assessment of patient history and imaging.
Implications:
- Avoiding misdiagnosis of subdural hematoma versus leptomeningeal malignancy is vital for appropriate treatment.
- Clinicians must employ analytical thinking to navigate diagnostic pitfalls and prevent patient complications.