A case of recurrent gliosarcoma mimicking subdural hematoma

The authors present the case of a patient who after undergoing craniotomy for glioblastoma resection was found to have gliosarcoma recurrence in the subdural space without intraparenchymal recurrence. A 74-year old man originally presented with the first seizure of his life and was found to have a right temporal glioblastoma multiforme. He underwent craniotomy and adjuvant chemotherapy and radiation therapy. Five months later, he presented with what was to be presumed to be a right subdural hematoma found on surveillance imaging. After expanding on repeat imaging, the patient was electively taken for burr hole evacuation, however intraoperatively thickened membranes were encountered leading to craniotomy and resection of lesion with pathology consistent with gliosarcoma. What we describe is novel because not only was there rare subdural spread of previously resected glioblastoma observed, but also transformation to the more aggressive tumor of gliosarcoma. Thus, we add to the body of literature and evidence to the clinical consideration of glioma as a rare cause of non-traumatic subdural collection. Specifically in a population of patients who have already undergone glioma resections, work up of subdural collections should include contrasted MRI beyond CT. The treatment paradigm does not change in this presentation of glioma recurrence. Surgical decompression and resection to alleviate brain compression, followed by adjuvant chemotherapy and radiation.