A case of atypical chronic subdural hematoma: a spontaneous rupture of dural lymphoma nodule.
In forensic medicine, a chronic subdural hematoma (SDH) usually results from trauma, sometimes minimal for elderly people. The case reported here is a forensic medical description of an atypical chronic subdural hematoma. A woman aged of 40-year-old died following a coma. The autopsy and histological analyses revealed the hemorrhagic disintegration of a lymphoid nodule, a metastasis from generalized lymphoma. The combination of chronic symptomatic SDH and a tumor of the dura mater have been described, but are very rare. The possibility of trauma, even minimal, has never been excluded in these cases. In fact, the clinical picture of these patients suggested a significant movement of the brain within the cranial cavity due to the physiological decrease in brain volume. In the reported case, this particular process was excluded since the spontaneous hemorrhagic effusion produced by the meningeal lymphoid nodule was the cause of the chronic SDH. This pathophysiological explanation was possible because the entire brain and meninges were removed for histological analysis. Trauma, even minimal trauma, is not always involved in the formation of a chronic SDH.
Laboratory of Forensic Medicine, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes cedex, France.
Lucia
L
Barrios
Laboratory of Forensic Medicine, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes cedex, France. Electronic address: renaud.clement@univ-nantes.fr.
Renaud
R
Clément
Laboratory of Forensic Medicine, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes cedex, France.
Guillaume
G
Visseaux
Unit of Neurosurgery, CHU of Nantes, 1 place alexis Ricordeau, 44093 Nantes cedex 1, France.
Eric
E
Bord
Laboratory of Histopathology, Faculty of Medicine, 2 Avenue du Professeur Léon Bernard, 35043 Rennes cedex, France.
Francois
F
Le Gall
Laboratory of Forensic Medicine, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes cedex, France.
Olivier
O
Rodat
D000328:Adult; D003128:Coma / Q000209:etiology; D004388:Dura Mater / Q000473:pathology*; D005260:Female; D049429:Forensic Pathology; D020200:Hematoma, Subdural, Chronic / Q000473:pathology*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D008577:Meningeal Neoplasms / Q000473:pathology*; D012422:Rupture, Spontaneous / Q000473:pathology; D014842:von Willebrand Diseases / Q000150:complications
Chronic subdural hematoma; Effusion; Forensic medicine; Hemorrhage; Lymphoma