• Toshiya Ichinose, Megumi Ueno, Takuya Watanabe, Ken-Ichi Murakami, Hiroshi Minato, and Yutaka Hayashi.
• Department of Neurosurgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. Electronic address: t-ichinose@med.kanazawa-u.ac.jp.
• World Neurosurg. 2020 Jul 1; 139: 196-199.

BackgroundIncidence of chronic subdural hematoma (CSH) associated with metastases of extraneural malignancies is rare. We report a rare case of CSH wherein most of the CSH cavity was occupied with metastatic cancer cells; in addition, we review the literature.Case DescriptionA 68-year-old man with a history of gastric cancer presented to our hospital with dysarthria and shoulder paralysis; CSH was diagnosed from preoperative imaging findings. When the hematoma was removed via a small craniotomy, besides the hematoma, we observed an abnormal mass of tissue in the capsule. Pathologically, the mass was consistent with the findings of metastatic gastric cancer. Although the symptoms immediately disappeared postoperatively, a symptomatic acute subdural hematoma with midline shift was observed on postoperative day 27. Emergency craniotomy and hematoma and tumor removal were performed. Pathologic examination showed hemorrhagic necrosis in the tumor, which had not been initially observed. The postoperative course progressed without hematoma recurrence.ConclusionsTo the best of our knowledge, this is the first report of a CSH accompanied by tumor metastasis in most of the CSH cavity. Although rare, if a patient with cancer has CSH, the CSH should be treated considering the possibility of metastasis.Copyright © 2020 Elsevier Inc. All rights reserved.

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