Case Study
Brain Tumour Mimicking Acute Subdural Haematoma
Background
A patient, who was in his 60s, was admitted to the Emergency department of CMRI with a history of speaking difficulty, related to finding the right word, and a weakness on the right side. He had become bed-ridden and was unable to speak for 1-2 weeks. He was first admitted to a hospital in his hometown but due to lack of neurosurgical services, he was referred to a multi-speciality hospital in Kolkata. A CT scan of his brain revealed a possible acute subdural hematoma – bleeding between the surface of the brain and the brain covering or dura. Unfortunately, his family was told he was unlikely to survive and was transferred to CMRI.
Investigation & Analysis
Although his scans had a typical appearance of a left sided acute subdural haematoma, there was a lot of swelling or oedema in the same cerebral hemisphere as well. This raised a suspicion that there might be an underlying tumour which might have been the cause of the bleeding. Hence a CT head with contrast was performed and this confirmed our suspicion.
Treatment
Because there was significant mass effect from the acute subdural haematoma, we proceeded to prepare for an operation to remove the haematoma via a craniotomy and also since there was a swelling in his brain, he was given high dose steroids prior to his surgery.
We were in for a surprise when we actually removed the bone flap from his skull and discovered that the part which we thought was an acute subdural haematoma, was actually a tumour of the covering of the brain or the meninges. We went ahead with a successful resection of more than 98% of the tumour.
The whole specimen was sent for a Histopathological examination, which takes about 7-10 days to come back.
Post-operative care
The patient has been recovering well and is still on high dose steroids to counter the swelling of his brain post-resection. He has started speaking a few words now and his right sided weakness has improved significantly.
