Prostate adenocarcinoma dural metastasis mimicking a subacute subdural hematoma

Patients with malignancies that have a propensity to develop dural metastasis can present a dural infiltration mimicking a subdural hematoma. Dural metastases originating from prostate cancer mimicking a subdural hematoma are rare.

The authors describe the case of a 66-year-old man with a history of prostate adenocarcinoma with vertebral metastases who complained of headaches, weakness, anorexia, and dizziness for 1 month. A head computed tomography scan without contrast demonstrated a right pan-hemispheric subdural collection, which was reported to be a subacute subdural hematoma. Due to the patient's history of prostate carcinoma, brain magnetic resonance imaging (MRI) with and without gadolinium was requested before the surgery, which showed substantial enhancement of the subdural collection, suggesting a tumoral collection. Based on the MRI findings, an open biopsy was performed, revealing extensive bone infiltration and a thickened dura with a large subdural tumoral component suggestive of disseminated pachymeningeal carcinomatosis. No hematoma was identified.

This case report demonstrated how metastatic lesions can mimic subdural hematomas. This disease carries a poor prognosis. Diagnosing and managing this rare entity warrants high suspicion to guide the patient and the family members in decision-making.