Subdural haematoma mimicking empyema in a patient with multiple sclerosis treated with immunosuppressive monoclonal antibody
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Student Research Group of Neurology, Medical University of Lublin
Chair and Department of Neurology, Medical University of Lublin
J Pre Clin Clin Res. 2018;12(4):120–122
Subdural empyema (SE) and subdural haematoma (SH) can present similar radiological signs on magnetic resonance imaging (MRI) of the brain. Natalizumab, a monoclonal antibody used in the treatment of multiple sclerosis (MS), exerts immunosuppressive effects in the CNS and can rarely be complicated by progressive multifocal leukoencephalopathy. In a 39-year-old female treated because of MS with natalizumab, control MRI showed massive thickening of the meninges and multiple fluid reservoirs, described as most probably empyemas and meningitis. The patient denied head trauma. Laboratory tests did not show inflammation. Orthopantomogram showed dental pathologies – a possible source of infection. Despite intense treatment, the MRI lesions remained unchanged. After neurosurgical intervention, chronic SH was diagnosed. A radiological picture of SH and SE could be difficult to differentiate. The aim of the article is to show how unspecific signs in neuroimaging can be caused by chronic SH.

Anna Jamroz-Wiśniewska   
Chair and Department of Neurology, Medical University of Lublin
1. Illescu IA. Current diagnosis and treatment of chronic subdural haematomas. J Med Life. 2015; 8(3): 278–284.
2. French H, Schaefer N, Keijzers G, Barison D, Olson S. Intracranial subdural empyema: a 10-year case series. Ochsner J. 2014; 14(2): 188–94.
3. Doan N, Patel M, Nguyen HS, Mountoure A, Shabani S, Gelsomino M, et al. Intracranial subdural empyema mimicking a recurrent chronic subdural hematoma. J Surg Case Rep. 2016; 9: 1–2.
4. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016; 11(4): 330–342.
5. Iorio-Morin C, Touchette C, Lévesque M, Effendi K, Fortin D, Mathieu D. Chronic Subdural Hematoma: Toward a New Management Paradigm for an Increasingly Complex Paradigm. J Neurotrauma 2018; 35(16): 1882–1885.
6. Neto JF, Araujo JLV, Ferraz VR, Haddad L, Veiga JCE. Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases. Rev Col Bras Cir. 2015; 42(5): 283–287.
7. Gelabert-Gonzalez M, Rico-Cotelo M, Aran-Echabe E. Chronic subdural hematoma. Med Clin (Barc). 2015; 144(11): 514–519.
8. Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014; 121(3): 665–673.
9. Grelat M, Madkouri R, Bousquet O. Acute isodense subdural hematoma on computed tomography scan – diagnostic and therapeutic trap: a case report. J Med Case Rep. 2016; 10: 43.
10. De Beer MH, Van Gils P, Koppen H. Mimics of subacute subdural hematoma in the ED. Am J Emerg Med. 2013; 31(3): 634.e1–3.
11. Catana D, Koziarz A, Cenic A, Siddharth N, Singh S, Almenawer SA, et al. Subdural Hematoma Mimickers: A Systematic Review. World Neurosurg. 2016; 93: 73–80.
12. Fobben ES, Grossman RI, Atlas SW, Hackney DB, Goldberg HI, Zimmerman RA, et al. MR Characteristics of Sudural Hematomas and Hygromas AT 1.5T. AJR Am J Roentgenol. 1989; 153(3): 589–595.
13. De Bonis P, Anile C, Pompucci A, Labonia M, Lucatntoni C, Mangiola A. Cranial and spinal subdural empyema. Br J Neurosurg. 2009; 23(3): 335–340.
14. Jaskólski DJ. Ropniaki wewnątrzczaszkowe. Aktualn Neurol 2014; 14(2): 112–116.
15. Butzkueven H, Kappos L, Pellegrini F, Trojano M, Wiendl H. Patel RN, et al. Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results. J Neurol Neurosurg Psychiatry 2014; 85(11): 1190–1197.
16. Natalizumab. In: Aronson JK, editors. Meyler’s Side Effects of Drugs.16th ed. Elsevier; 2016. p. 33–36.