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Images in Neurology
July 2014

Suspected Subdural Hematoma

Author Affiliations
  • 1Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
  • 2Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
JAMA Neurol. 2014;71(7):916-917. doi:10.1001/jamaneurol.2013.6013

A 71-year-old woman was admitted for 3 inaugural right-sided focal seizures. Shortly before, she had experienced a minor head trauma. Her neurological examination finding was normal. A brain computed tomographic scan and magnetic resonance imaging (MRI) showed abnormalities supporting the diagnosis of chronic subdural hematoma (SDH), with a subcutaneous collection regarding this subdural hematoma (Figure, A-C). She did not undergo surgery, and monitoring with brain MRI was recommended. Three months later, while partial seizures persisted despite anti-epileptic treatment (levitiracetam, 2000 mg/d), follow-up brain MRI showed increased extra-axial and subcutaneous gadolinium-enhanced masses (Figure, D and E). Given this unusual subdural hematoma evolution and radiological worsening of the suspected hematoma, craniotomy and biopsies were performed. The histopathology findings revealed a low-grade B-cell marginal zone lymphoma involving dura with bone and scalp invasion. The patient underwent radiotherapy after surgery, which reduced the residual mass. Six months later, her neurological condition deteriorated with progressive appearance of a right hemiparesis, aphasia, and drug-resistant epilepsy.

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