2018 Volume 23 Issue 2 Pages 146-150
Lesions that mimic subdural hematomas have been reported and may be difficult to diagnose. We report a case in which treatment was initiated based on a diagnosis of chronic subdural hematoma resulting from head trauma; however, in reality, it was a metastatic malignant lymphoma. The patient was a 61‒year‒old woman with a medical history of rheumatoid arthritis, hypertension, and malignant lymphoma (tonsil). The patient had hit her head on an iron pipe when she stood up. Eighteen days after the injury, she developed numbness of the right upper and lower limbs, and visited a neurosurgeon. Magnetic resonance imaging (MRI) of her head revealed a subdural hematoma. Although her symptoms gradually improved, computed tomography (CT) of her head 32 days after the injury showed an increase in the left subdural hematoma. This resulted in a visit to the neurosurgery department in our hospital. We diagnosed it as a chronic subdural hematoma based on the patient’s clinical course and images, and treated it conservatively. We initially treated the patient as an outpatient, however, because of the appearance of headache and nausea, she underwent burr hole surgery on Day 37 after injury; it was not successful because the subdural hematoma was stiff. A craniotomy was then performed, during which the subdural hematoma was partially removed. As the patient’s symptoms improved, she was discharged from the hospital. She then developed an articulation disorder on Day 97 after the injury, and again visited our neurosurgery department. Tumorous lesions were suspected after performing CT and MRI scans of her head, and craniotomy was performed. She was then diagnosed with malignant lymphoma and chemotherapy was initiated. Malignant lymphoma may be difficult to distinguish from subdural hematoma by CT and MRI of the head alone. In this case, the patient was erroneously diagnosed with chronic subdural hematoma thought to have resulted from a head injury, and was treated for this condition. We recommend pathological diagnosis in cases in which a chronic subdural hematoma has an unusual appearance during burr hole surgery.
