Interhemispheric subdural hematoma and incidental multiple myeloma in a trauma patient

Case contributed by Dr Dayu Gai

Presentation

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 years
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 hematoma extending into the left-sided T3-T4 neural exit foramen.
  • There is a subdural hematoma in the interhemispheric fissure and on the tentorium.

Case Discussion

This patient has two main issues:

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

While traumatic subdural hematomas are common, interhemispheric subdural hematomas are rare 1. They are associated with traumatic venous tearing of the parasagittal bridging veins. In our patient, the hyperdense hematoma can best be visualized on the coronal and sagittal views. This is in contrast with typical subdural hematomas, 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 hematoma.
While there are clear management algorithms for the management of acute subdural hematoma. The management for interhemispheric subdural hematomas are less clear 2. There is no clear benefit of surgical vs. conservative management in these uncommon hematomas.

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
Published: 28th Feb 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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