A 77-year-old woman who fell twice and later developed weakness, memory issues, and headaches was found to have a rare form of lymphoma in her brain’s protective lining. Her case, reported by neurosurgeons and pathologists in Chihuahua, Mexico, highlights how a condition mimicking a chronic subdural hematoma can be something far less common. When surgeons opened her skull, the tissue they removed turned out to be a rare form of lymphoma growing in the brain’s protective lining, a finding published on September 5 in Cureus.
A Diagnosis That Didn’t Add Up
The woman’s symptoms—weakness on her right side, memory problems, and a persistent headache—initially pointed to a chronic subdural hematoma, a slow bleed between the brain and its outer covering. This condition often follows minor trauma in older adults and can resemble stroke or dementia. Before surgery, the team’s working diagnosis was a probable traumatic subdural hematoma, with an arachnoid cyst as the alternative. Blood work also revealed low white cell counts and severe anemia, with hemoglobin levels of 6.7 g/dL, further complicating the picture.
Her CT scan showed a 6-by-3-centimeter lesion over the left side of her brain, dark and lens-shaped, consistent with an older blood collection. However, her MRI revealed unusual features: the lesion pressed on a ventricle, and the adjacent dura showed uniform enhancement after contrast. These findings, along with low white cell counts and severe anemia, suggested something more complex than a simple bleed.
Surgery Reveals a Rare Lymphoma
Surgeons performed a craniotomy and drained what appeared to be a cystic lesion. Instead of finding clot membranes, they discovered a markedly thickened dura mater. Pathology confirmed follicular non-Hodgkin lymphoma, a type that rarely involves the dura. This subtype accounts for about 20% of non-Hodgkin lymphomas overall but is exceptionally rare in the brain’s protective lining.
The woman’s recovery after surgery was initially promising, but she died two months later. Her case shows that even slow-growing lymphomas can have unpredictable outcomes, especially in older patients with other health conditions. The authors caution that a hopeful post-surgery recovery and low-grade pathology do not guarantee long-term survival. The National Cancer Institute (NCI) notes that median survival for follicular lymphoma, even in advanced stages, is 8 to 15 years, showing the unusual aggressiveness of this case.
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This case adds to a small list of reports where dural lymphomas mimic subdural hematomas. They emphasize that tissue analysis is key for diagnosis, particularly in elderly patients without clear head trauma. While most subdural collections after falls are indeed bleeds, unusual symptoms or imaging findings warrant closer scrutiny.
Unusual Symptoms and Imaging Findings
The woman’s case presented several unusual features that prompted further investigation. Despite her falls, there was no clear head injury, and her neurological decline occurred gradually over weeks. This slow progression, along with her unexplained low blood counts, raised concerns beyond a typical subdural hematoma. Her falls, from standing height without obvious head impact or loss of consciousness, further complicated the typical trauma narrative.
Her MRI findings were particularly telling. The uniform enhancement of the dura after contrast administration was inconsistent with a hematoma, where enhancement is usually limited to the clot’s membrane and appears uneven.
The Rarity of Dural Lymphoma
Dural lymphomas are exceptionally rare, and the follicular subtype is even rarer. According to the authors, lymphomas originating in the central nervous system account for only 1% to 7% of non-Hodgkin lymphomas. Among these, dural lymphomas are uncommon, and the follicular subtype is an unusual variant within this group. The authors’ literature review identified only one prior case of grade I follicular lymphoma involving the dura, reported in 2006, which had mimicked a meningioma rather than a subdural hematoma.
The woman’s tumor exhibited a Ki-67 proliferation index of 30%, indicating a higher rate of cell division than typically seen in low-grade lymphomas. This finding, along with her advanced age and systemic health conditions, may have contributed to her rapid decline despite the tumor’s usually slow-growing nature.