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Malignant Meningioma Mimicking Chronic Subdural Hematoma
Kenji Miki1, Yasutoshi Kai1, Yuka Hiraki2
1Department of Neurosurgery, Aso Iizuka Hospital, Yoshio-machi, Iizuka, Fukuoka, Japan.
Insights
A rare case highlights that brain tumors can mimic chronic subdural hematoma (CSDH) on CT scans. Neurosurgeons should consider atypical diagnoses beyond CSDH, even with typical imaging findings.
Area of Science:
- Neurosurgery
- Neuropathology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition typically diagnosed via CT scans.
- Accurate diagnosis is crucial for effective patient management and surgical planning.
- This report details a unique case where initial CT findings suggested CSDH but masked an underlying meningioma.
Purpose of the Study:
- To report a rare case of atypical meningioma misdiagnosed as CSDH based on CT imaging.
- To emphasize the importance of considering differential diagnoses in neurosurgical cases.
- To alert clinicians to potential diagnostic challenges in neuroimaging.
Main Methods:
- A case study of a 91-year-old female patient presenting with dizziness.
- Initial diagnosis of CSDH based on computed tomography (CT) findings.
- Surgical intervention followed by pathological examination revealing an atypical meningioma.
Main Results:
- CT imaging initially indicated CSDH, leading to burr hole surgery.
- Intraoperative findings revealed a tumor beneath the dura, not a typical hematoma.
- Postoperative pathological examination confirmed atypical meningioma as the true diagnosis.
Conclusions:
- CT imaging is highly effective for diagnosing CSDH in most cases.
- This case underscores that meningioma can present with imaging features mimicking CSDH.
- Clinicians must maintain a high index of suspicion for alternative diagnoses to avoid misdiagnosis.
Background:
Chronic subdural hematoma (CSDH) is the most common disease encountered in neurosurgery. Diagnoses of CSDH are usually made on the basis of computed tomography (CT) images. In this report, we discuss the case of a patient with meningioma whose findings instead suggested CSDH.
Case Description:
A 91-year-old woman complained of dizziness. Brain CT imaging revealed a low-density subdural space, following which we diagnosed her with CSDH. On the same day, we performed burr hole surgery. However, when opening the burr hole and cutting the dura, a light yellowish tumor was observed under the dura. After the operation, her condition deteriorated and she died 2 days later. After 10 days, pathologic examination of the tumor specimen led to a diagnosis of atypical meningioma.
Conclusions:
In almost all cases, CSDH can be diagnosed using CT images only. However, our patient's true diagnosis was meningioma, rather than CSDH. We rouse attention not to take it for CSDH with a CT image easily.
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