gms | German Medical Science

Objective: Central nervous system metastasis of prostate adenocarcinoma is very rare indeed and has been occasionally described in literature. This series describes 4 patients presenting with clinical symptoms and radiological findings of subacute subdural haematoma and 2 patients with radiologically confirmed meningioma ‘en plaque’ with review of the current literature.

Case presentation: During the last 5 years, 4 patients were sent to the Elisabeth Hospital in The Netherlands presenting with clinical and radiological features of subacute subdural haematoma (SDH) after minor head injury. Prior to the injury all had been diagnosed with prostate cancer and had received or still were on hormone therapy. All had single twist drill burr-hole semi-urgently, a technique used in our department as standard, to evacuate subacute or chronic subdural haematoma. The findings during surgery did not correspond to the normal findings in SDH, but instead a glassy, consistent mass was present, which was revealed to be a metastasis of a prostate carcinoma by pathological examination.

The 2 other patients had CT and MRI scan of the brain due to headache. These patients were initially diagnosed with meningioma, but in these patients pathological analysis of the tissue samples proved prostate metastases as well.

Conclusions: Dural metastasis associated with SDH has been sporadically described in the literature, but subdural metastasis of the prostate mimicking subacute SDH is extremely rare.

In our practice, 4 similar cases were encountered with pre-operative looks of subacute SDH, which in fact proved to harbour prostate metastases in all cases. This could demonstrate the need for broader diagnostics in patients presenting with seemingly straightforward subacute SDH, especially in those with prior diagnosis of malignancy.