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Intracranial multiple myeloma masquerading as subdural hematoma: illustrative cases
Stephanie A Ihezie1, Vishva Natarajan1, George Zanazzi2,3
1Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Journal of Neurosurgery. Case Lessons
|August 11, 2025
Summary
Intracranial multiple myeloma (MM) can mimic subdural hematoma (SDH). Prompt diagnosis and tailored treatment, including chemotherapy and radiation, led to positive outcomes in two patients with MM presenting as subdural masses.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Intracranial involvement in multiple myeloma (MM) is rare and often misdiagnosed as subdural hematoma (SDH).
- This presentation is associated with a poor prognosis.
Purpose of the Study:
- To present a case series of intracranial MM mimicking SDH.
- To highlight diagnostic and therapeutic considerations.
Main Methods:
- Case series of two elderly female patients with subdural masses.
- Diagnostic workup included imaging and biopsy.
- Treatment involved corticosteroids, radiation therapy, and systemic chemotherapy.
Main Results:
- Biopsies confirmed plasma cell neoplasms.
- Both patients experienced clinical and radiographic improvement after treatment.
- Nonoperative management was effective despite mass effect.
Conclusions:
- Maintain a broad differential diagnosis for subdural collections, especially with vasogenic edema or a history of MM.
- Intracranial MM, though rare, is treatable with a combination of therapies.
- Early recognition and management can lead to favorable outcomes.
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