title: Intracranial multiple myeloma may imitate subdural hemorrhage: How to overcome diagnostic limitations and avoid errors in treatment.
abstract: BACKGROUND
  Although the diagnosis of subdural hematoma is usually straightforward, occasionally it may be erroneous, leading to mistakes in the treatment. For example, leptomeningeal malignancies, even in the absence of bleeding, may clinically and radiologically mimic subdural hemorrhage.
  
  
  OBJECTIVE
  To stress the importance of not only intuitive thinking but also in analytic thinking in appropriate and accurate treatment strategies.
  In this report, the clinical and radiological pitfalls in differentiating malignant leptomeningeal infiltration and subdural hematomas are discussed. A sample case of an intracranial extra-osseous manifestation of a multiple myeloma that is atypical with regard to its location and clinical presentation is presented for illustration.
  
  
  CONCLUSIONS
  The variability of intracranial presentation and the wide spectrum of leptomeningeal malignancies necessitate careful preoperative evaluation of the patient's individual history as well as radiological images to avoid misdiagnosis. A clinician who has become familiar with the pitfalls in the differential diagnosis between leptomeningeal infiltrations and subdural hematoma will act more analytically to solve the patient's problems properly and avoid potential complications for the patient.
authors.affiliation: Department of Neurosurgery, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany; Department of Neurosurgery, Universitätsmedizin Mainz, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Prajsnar-Borak
authors.affiliation: Department of Neurosurgery, Istanbul Üsküdar State Hospital, Üsküdar, Istanbul, Turkey. Electronic address: drnacibalak@yahoo.com.
authors.forename: Naci
authors.initials: N
authors.lastname: Balak
authors.affiliation: Department of Neuropathology, Universitätsmedizin Mainz, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Von Pein
authors.affiliation: Department of Neurosurgery, Universitätsmedizin Mainz, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Glaser
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mainz, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Boor
authors.affiliation: Department of Neurosurgery, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Stadie
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Diagnostic pitfall; Metastases; Multiple myeloma; Subdural hemorrhage