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[A case report of chronic encapsulated intracerebral hematoma]
Y Suyama1, H Kajikawa, K Yamamura
1Section of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
Abstract:
Chronic encapsulated intracerebral hematoma is a rare clinicopathological entity. The authors reported a case of a 52-year-old male who presented with progressive sensory disturbance of the left extremities three weeks prior to admission. Plain CT and MRI scans revealed a subcortical mass in the right temporal lobe associated with extensive peritumoral edema and intratumoral hemorrhage (mixed intensity on T1WI, low intensity on T2WI). There was a ring-like enhancement with GdDTPA. These findings strongly suggested metastatic melanoma associated with intratumoral hemorrhage. During the operation, the mass appeared partly at the surface of the brain and was easily extirpated totally. Histologically, the specimen showed chronic encapsulated hematoma with a thick, fibrous capsule and there was no evidence of neoplasm. The postoperative course was uneventful and follow up CT scan showed disappearance of the mass and the surrounding edema. The relevant literature was reviewed, and the pathogenesis of this entity was discussed.
Insights
A rare chronic encapsulated intracerebral hematoma mimicked brain tumors on imaging. Surgical removal confirmed it was a benign hematoma, not metastatic melanoma, resolving symptoms.
Area of Science:
- Neurology
- Neurosurgery
- Pathology
Background:
- Chronic encapsulated intracerebral hematoma is a rare condition.
- Distinguishing it from neoplastic lesions is clinically significant.
Observation:
- A 52-year-old male presented with progressive left-sided sensory disturbance.
- CT and MRI revealed a right temporal lobe subcortical mass with edema and hemorrhage, enhancing with GdDTPA.
- Initial imaging suggested metastatic melanoma.
Findings:
- Surgical exploration revealed a mass with a thick fibrous capsule.
- Histopathological examination confirmed a chronic encapsulated hematoma without evidence of neoplasm.
- Postoperative imaging showed complete resolution of the mass and edema.
Implications:
- This case highlights the importance of considering rare entities in differential diagnosis.
- Accurate diagnosis of chronic encapsulated hematoma is crucial for appropriate management.
- Complete surgical excision leads to favorable patient outcomes.