Prajsnar-Borak Anna, Balak Naci, Von Pein Harald, Glaser Martin, Boor Stephan, Stadie Axel
Department of Neurosurgery, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany; Department of Neurosurgery, Universitätsmedizin Mainz, Germany.
Department of Neurosurgery, Istanbul Üsküdar State Hospital, Üsküdar, Istanbul, Turkey.
Neurol Neurochir Pol. 2017 May-Jun;51(3):252-258. doi: 10.1016/j.pjnns.2017.02.005. Epub 2017 Mar 27.
Although the diagnosis of subdural hematoma is usually straightforward, occasionally it may be erroneous, leading to mistakes in the treatment. For example, leptomeningeal malignancies, even in the absence of bleeding, may clinically and radiologically mimic subdural hemorrhage.
To stress the importance of not only intuitive thinking but also in analytic thinking in appropriate and accurate treatment strategies.
In this report, the clinical and radiological pitfalls in differentiating malignant leptomeningeal infiltration and subdural hematomas are discussed. A sample case of an intracranial extra-osseous manifestation of a multiple myeloma that is atypical with regard to its location and clinical presentation is presented for illustration.
The variability of intracranial presentation and the wide spectrum of leptomeningeal malignancies necessitate careful preoperative evaluation of the patient's individual history as well as radiological images to avoid misdiagnosis. A clinician who has become familiar with the pitfalls in the differential diagnosis between leptomeningeal infiltrations and subdural hematoma will act more analytically to solve the patient's problems properly and avoid potential complications for the patient.
虽然硬膜下血肿的诊断通常很直接，但偶尔也可能出现错误，从而导致治疗失误。例如，柔脑膜恶性肿瘤即使没有出血，在临床和影像学上也可能模仿硬膜下出血。
强调在制定恰当且准确的治疗策略时，不仅直观思维而且分析思维都很重要。
在本报告中，讨论了鉴别恶性柔脑膜浸润和硬膜下血肿时的临床和影像学陷阱。展示了一例多发性骨髓瘤的颅内骨外表现病例，该病例在位置和临床表现方面不典型。
颅内表现的多样性以及柔脑膜恶性肿瘤的广泛谱系，需要对患者的个人病史以及影像学图像进行仔细的术前评估，以避免误诊。熟悉柔脑膜浸润和硬膜下血肿鉴别诊断陷阱的临床医生将更具分析性地采取行动，妥善解决患者问题并避免患者出现潜在并发症。
