Metastatic coagulopathic subdural hematoma: A dismal prognosis

BACKGROUND: Dural metastases have been found in about 8–9% of patients who died of cancer, in most autopsy series. Dural metastases presenting with chronic subdural hematoma are rare, with only about 55 cases reported in the literature. CASE DESCRIPTION: We discuss the case of a 72 year old gentleman with prostate cancer who presented with a chronic subdural hematoma which was drained surgically. He was found to have disseminated intravascular coagulation (DIC) and recurrence of the subdural hematoma for which further drainage was required. After the second drainage of the chronic subdural hematoma, dural metastases were diagnosed from the pathology specimens. CONCLUSION: On reviewing the literature, 25 cases of dural metastases with chronic subdural hematoma and coagulopathy were found. These cases were characterized by the fact that they had a very poor clinical outcome in spite of surgical drainage. This combination could be a distinct entity and its recognition is important to guide management of this rare condition.