An unusual extra‑axial hypodense lesion mimicking a chronic subdural haematoma

R Ramnarayan; T V Anilkumar; Rani Nayar

doi:10.4103/0976-3147.112774

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Case Report

4 (

); 216-219

doi:

10.4103/0976-3147.112774

An unusual extra‑axial hypodense lesion mimicking a chronic subdural haematoma

R Ramnarayan, T V Anilkumar¹, Rani Nayar¹

Departments of Neurosurgery, Apollo Hospital, Chennai, India

1Department of Neurology, Dr SMCSI Medical College Hospital, Karakonam, India

Address for correspondence: Dr. R. Ramnarayan Department of Neurosurgery, Apollo Hospital Chennai India r_ramnarayan@yahoo.com

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

A 59-year-old man was found on the road with multiple injuries. CT scan showed a hypodense extra axial lesion in the left fronto‑temporal region suggestive of chronic subdural haematoma. He was treated conservatively but did not improve. He underwent craniectomy after lesion was shown to be increasing in size, only solid tissue was seen which was not biopsied. Patient made good recovery after steroids were put on. He deteriorated again 6 weeks later and radiology showed the frontal lesion without involvement of the brain and with minimal enhancement and mass effect. He underwent biopsy decompression of the lesion with steroids, post‑operatively he improved well, but deteriorated when the steroids were tapered. Histopathology report was Non‑Hodgkin’s lymphoma. No primary was found and the patient died during oncology treatment. This illustrates manifestation of primary dural lymphoma radiologically mimicking chronic subdural haematoma, another common disorder.

Keywords

Chronic subdural haematoma

extra‑axial hypodense lesion

lymphoma

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Conflict of Interest

None declared

References

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[1] Hochberg F. H., Miller D. C., . Primary central nervous system lymphoma. J Neurosurg. 1988;68:835-53.
[Google Scholar]

[2] Murphy J. K., O’Brien C. J., Ironside J. W., . Morphologic and immunophenotypic characterization of primary brain lymphomas using paraffin-embedded tissue. Histopathology. 1989;15:449-60.
[Google Scholar]

[3] O’Neill B. P., Illig J. J., . Primary central nervous system lymphoma. Mayo Clin Proc. 1989;64:1005-20.
[Google Scholar]

[4] Lachance D. H., O’Neill B. P., Macdonald D. R., Jaeckle K. A., Witzig T. E., Li C. Y., et al . Primary leptomeningeal lymphoma: Report of 9 cases, diagnosis with immunocytochemical analysis, and review of the literature. Neurology. 1991;41:95-100.
[Google Scholar]

[5] Scotti G, Terbrugge K, Melancon D, Belanger G, . Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg. 1977;47:311-5.
[Google Scholar]

[6] Goetz P, Lafuente J, Revesz T, Galloway M, Dogan A, Kitchen N, . Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue of the dura mimicking the presentation of an acute subdural hematoma. Case report and review of the literature. J Neurosurg. 2002;96:611-4.
[Google Scholar]

[7] Reyes M. G., Homsi M. F., Mangkornkanong M, Stone J, Glick R. P., . Malignant lymphoma presenting as a chronic subdural hematoma. Surg Neurol. 1990;33:35-6.
[Google Scholar]

[8] Matano S, Sakashita Y, Furusho H, Ohashi M, Terahata S, Kakuma K, et al . Primary leptomeningeal lymphoma. J Neurooncol. 2001;52:81-3.
[Google Scholar]

[9] Altundag M. K., Ozosik Y, Yalcin S, Akyol F, Uner A, . Primary low grade B-cell lymphoma of the dura in an immunocompetent patient. J Exp Clin Cancer Res. 2000;19:249-51.
[Google Scholar]

[10] Amaker B. H., Ghatak N. R., Jebraili S. A., Ferreira-Gonzalez A, Kornstein M. J., . Primary T-cell-rich B-cell lymphoma masquerading as a meningioma. Arch Pathol Lab Med. 2000;124:1700-3.
[Google Scholar]

[11] Freudenstein D, Bornemann A, Ernemann U, Boldt R, Duffner F, . Intracranial malignant B-cell lymphoma of the dura. Clin Neuropathol. 2000;19:34-7.
[Google Scholar]

[12] Kumar S, Kumar D, Kaldjian E. P., Bauserman S, Raffeld M, Jaffe E. S., . Primary low-grade B-cell lymphoma of the dura: A mucosa associated lymphoid tissue-type lymphoma. Am J Surg Pathol. 1997;21:81-7.
[Google Scholar]

[13] Kambham N, Chang Y, Matsushima A. Y., . Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) arising in dura. Clin Neuropathol. 1998;17:311-7.
[Google Scholar]

[14] Iwamoto F. M., DeAngelis L. M., Abrey L. E., . Primary dural lymphomas: A clinicopathologic study of treatment and outcome in eight patients. Neurology. 2006;66:1763-5.
[Google Scholar]

[15] Iwamoto F. M., Abrey L. E., . Primary dural lymphomas: a review. Neurosurg Focus. 2006;15(21):E5.
[Google Scholar]

[16] Abdullah S, Morgensztern D, Rosado M. F., Lossos I. S., . Primary lymphoblastic B-cell lymphoma of the cranial dura mater: A case report and review of the literature. Leuk Lymphoma. 2005;46:1651-7.
[Google Scholar]

[17] Mongia S, Shukla D, Indira Devi B, Reddy T. V., . Primary cranial vault non-Hodgkin’s lymphoma. Neurol India. 2003;51:293-4.
[Google Scholar]

An unusual extra‑axial hypodense lesion mimicking a chronic subdural haematoma

Abstract

ABSTRACT

Keywords

Chronic subdural haematoma

extra‑axial hypodense lesion

lymphoma

Conflict of Interest

References

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