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Case Reports
. 2024 Nov 22;16(11):e74206.
doi: 10.7759/cureus.74206. eCollection 2024 Nov.

Intracranial Extramedullary Hematopoiesis Simulating a Subdural Hematoma: A Case Report

Wisam Al-Saad  1 , Pir Abdul Ahad Aziz Qureshi  2   3 , Vikram Rao Bollineni  1   3 , Thordur Tryggvason  4
Affiliations
Case Reports

Intracranial Extramedullary Hematopoiesis Simulating a Subdural Hematoma: A Case Report

Wisam Al-Saad et al. Cureus. .

Abstract

A 68-year-old patient came to the emergency department complaining of headaches and general weakness for the past month. The patient is known to have myeloproliferative disease. Non-contrast computer tomography showed a hyperdense extra-axial collection in bilateral frontoparietal regions, which was presumed to be bilateral subdural hematoma as the initial diagnosis. A drainage procedure using a borehole was performed, and a solid substance was aspirated instead of blood. Subsequently, the diagnosis of an extramedullary hematopoiesis was made using histopathological and immunohistochemical techniques.

Keywords: extramedullary hematopoeisis; intracranial bleed; intracranial extramedullary haematopoiesis; intracranial hemorrage; subdural hemorrhage.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Non-contrast enhanced CT brain
Axial (A) and coronal (B) views show bilateral subdural hyperdense collections in the frontoparietal regions (blue arrows).
Figure 2
Figure 2. Histopathology of a sample taken from the subdural lesion
(A) 100x magnification, H&E staining (A), showing extramedullary hematopoiesis (white arrow) around a connective tissue (asterisk), and (B) 400x magnification, H&E staining, showing hematopoietic cells. Megakaryocytes (asterisk), granulocytes, normoblasts, and plasma cells (arrow), vary in degree of maturation.
Figure 3
Figure 3. MRI brain with and without contrast
T1-weighted axial view (A), T2-weighted axial view (B), FLAIR axial view (C), DWI axial view (D), T1-weighted post-contrast axial view (E), T1-weighted post-contrast coronal view (F), SWI axial view (G), and ADC axial view (H) reveal extra-axial lesions bilaterally along the cerebral convexities showing uniform mild post-contrast enhancement (blue arrows). These show iso to slightly hypointense T1 and heterogeneous T2 signal intensity, relatively high signal intensity on the FLAIR image, and susceptibility artifact on the SWI image, suggesting hemosiderin disposition. There is no diffuse restriction within the lesions. DWI: diffusion-weighted imaging; SWI: susceptibility-weighted imaging; ADC: apparent diffusion coefficient; FLAIR: fluid-attenuated inversion recovery
See this image and copyright information in PMC

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