• Abdullah M Abunimer, Hussam Abou-Al-Shaar, Timothy G White, Jian Y Li, and David J Chalif.
• Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2019 May 1; 125: 343-346.

BackgroundMetastatic subdural hematoma with dural metastasis in the setting of an underlying malignancy is a rare condition that is difficult to diagnose and associated with a poor prognosis. Knowledge of this rare entity is of a paramount importance to neurosurgeons, as its diagnosis may affect the management plan and overall survival. Here, we report a rare case of atraumatic subdural hematoma with dural metastasis in a patient with poorly differentiated adenocarcinoma of unknown origin.Case DescriptionA 34-year-old man presented with an insidious onset of headaches, severe light headedness, progressive low back pain, and generalized weakness for 2 weeks. On imaging, he was found to have left-sided acute on chronic subdural hematoma with midline shift. The patient underwent surgical evacuation of the hematoma and the subdural membrane was biopsied. Histopathologic examination revealed metastatic poorly differentiated adenocarcinoma of unclear origin. A full metastatic workup was unremarkable.ConclusionsMetastatic subdural hematoma with dural metastasis should be included in differential diagnosis of subdural hematoma, especially in patients with atypical presentation and in the presence of an underlying malignancy, as it may affect the management plan and overall survival.Copyright © 2019. Published by Elsevier Inc.

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