Interhemispheric subdural haematoma and incidental multiple myeloma in a trauma patient

Case contributed by Dr Dayu Gai

Presentation

This 85 year old gentleman fell down a set of stairs and hit his head on the bottom of the stair case. A CT brain and C-spine was performed.

Patient Data

Age: 85
Gender: Male
  • Multilevel spondyloarthrosis in the cervical spine with numerous wedge deformities in the lower cervical and upper thoracic spine region. In particular, the accompanying soft tissue swelling around the T3 vertebral deformity suggests either a focal lesion in the vertebral body or alternatively a fracture with surrounding haematoma extending into the left-sided T3-T4 neural exit foramen.
  • There is a subdural haematoma in the interhemispheric fissure and on the tentorium.

Case Discussion

This patient has two main issues:

  1. An acute interhemispheric subdural haematoma
  2. Incidental lytic lesions consistent with multiple myeloma

While traumatic subdural haematomas are common, interhemispheric subdural haematomas are rare 1. They are associated with traumatic venous tearing of the parasagittal bridging veins. In our patient, the hyperdense haematoma can best be visualised on the coronal and sagittal views. This is in contrast with typical subdural haematomas, which can be best appreciated on the axial views. Thus, it is important to image all three main views of the brain looking out for interhemispheric haematoma.
While there are clear management algorithms for the management of acute subdural haematoma. The management for interhemispheric subdural haematomas are less clear 2. There is no clear benefit of surgical vs. conservative management in these uncommon haematomas.

Multiple myeloma is common neoplastic disorder of plasma B cells. It is most commonly associated with punched out lytic lesions 3. In this patient, note the numerous lytic lesions spread through the cervical vertebra. These are classic for multiple myeloma.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 31991
Case created: 9th Nov 2014
Last edited: 5th Oct 2015
Inclusion in quiz mode: Included

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