Multiple metastases in central nervous system and subdural hematoma in the course of melanoma

Skin melanomas are malignant neoplasms originating from neuroectodermal melanocytic cells [1]. In Poland, melanomas are relatively rare – the standardized incidence rate is about 4.9/100,000. The most important factors of the increased risk of developing the disease are intense exposure to natural and artificial ultraviolet radiation, constant mechanical or chemical irritation, low pigment content in the skin and genetic predisposition. The recommended test used in the initial diagnosis is dermatoscopy or videodermoscopy. The basis for the diagnosis of skin melanomas is the histopathological examination of the entire excised pigmented lesion.
Brain metastases are the most frequently diagnosed intracranial tumours in adults; they are diagnosed about 10 times more often than primary tumours [2]. More than 80% of metastatic brain tumours are found after the diagnosis of the primary tumour [3]. The clinical symptoms of metastasis depend on the presence and growth of the tumour itself, accompanying cerebral white matter oedema and/or the development of hydrocephalus [4, 5]. The diagnosis is made on the basis of nuclear magnetic resonance (NMR) or computed tomography (CT) imaging tests.
Chronic subdural hematomas (CSDH) are most common among the elderly [6]. The predisposition of their occurrence among older patients is associated with the process of cerebral atrophy and reduction of its volume in the cranial cavity, and the weakening of the walls of superficial veins of the brain. Chronic subdural hematomas are most often manifested by headaches, progressive cognitive decline, personality changes, psychomotor retardation, paresis or aphasia. The decisive examination is CT of the head, which, with approx. 99.9% sensitivity, visualizes CSDH.
In 2015, a 63-year-old patient was admitted to the Department of Neurosurgery, Neurotraumatology and Paediatric Neurosurgery, Collegium Medicum Nicolaus Copernicus University in Bydgoszcz due to symptoms of progressive weakening of the muscles of the left limbs. The CT scan of the head revealed the presence of an extensive chronic right-sided cerebral hematoma. The patient denied the head injury. According to the data from the history, he was treated oncologically for dorsal melanoma about 10 years earlier. On admission, the patient was conscious, in logical verbal contact, slightly psychomotor slowed down, with a slight left-sided paresis. The patient underwent surgical treatment via craniotomy: the...


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