Dural prostate adenocarcinoma metastases mimicking and driving subdural hematoma: mechanistic insights from a case series.

Abstract

<h4>Background</h4>Intracranial dural metastases from extracranial malignancies, including prostate adenocarcinoma are rare, but they pose significant challenges due to atypical clinical presentations, unusual radiographic characteristics, and poor prognosis.<h4>Case presentations</h4>We present two patients with prostate adenocarcinoma who developed subdural hematoma (SDH) in association with dural metastatic disease. The first patient, a 58-year-old man, suffered a traumatic SDH that was initially managed with middle meningeal artery (MMA) embolization but presented with recurrent SDH requiring craniotomy and further MMA embolization, and ultimately craniectomy and mesh cranioplasty after documentation of a dural-based metastatic tumor at the chronic hematoma site. The second patient, a 63-year-old man with stage IV prostate cancer and known osseous metastases, was found to have a subacute SDH concomitant with a dural metastatic mass; he underwent craniectomy, and tumor resection . These cases illustrate two distinct presentations of dural metastasis with SDH - one appearing after a traumatic hemorrhage and one presenting as a hemorrhagic collection from bleeding of the underlying dural mass.<h4>Conclusions</h4>Prostate cancer dural metastasis can mimic or exacerbate SDHs, demanding a high index of suspicion in patients with known malignancy or atypical SDH features. Early use of contrast-enhanced MRI is crucial for diagnosis, and definitive management often requires a multidisciplinary approach.