Subdural Hematoma Mimickers: A Systematic Review.
BACKGROUND
A variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas.


METHODS
A systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes.


RESULTS
We included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes.


CONCLUSIONS
Identification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology.
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Dragos
D
Catana
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Alex
A
Koziarz
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Aleksa
A
Cenic
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Siddharth
S
Nath
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Sheila
S
Singh
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: Dr_menawer@hotmail.com.
Saleh A
SA
Almenawer
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Edward
E
Kachur
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D002494:Central Nervous System Infections / Q000175:diagnosis* / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Computed tomography; Magnetic resonance imaging; Mimic; Subdural hematoma; Subdural mass