{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:10:01Z","timestamp":1756278601222,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,11]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>A man in his 80s presented with 3\u2009weeks of lower back pain, generalised weakness, poor appetite and intermittent melena, without genitourinary symptoms or recent trauma. CT showed an old L1 compression fracture and new sclerotic lesions in the L3 and L4 vertebrae, as well as mildly enlarged abdominal lymph nodes. 3 days later, he returned to the emergency department with worsening symptoms, including new left hemiparesis. A head CT revealed a right subdural haematoma (SDH) with a midline shift. Despite treatment for disseminated intravascular coagulation, the patient\u2019s condition deteriorated, leading to a suspicion of spontaneous intracranial hypotension. An autopsy revealed disseminated metastatic adenocarcinoma with dura and leptomeningeal metastases, ultimately causing spontaneous SDH and subsequent transtentorial herniation. This case highlights the impact of anchoring bias in clinical decision-making and the importance of early recognition of underlying malignancy as the aetiology of spontaneous SDH in patients presenting with signs and symptoms of metastatic cancer.<\/jats:p>","DOI":"10.1136\/bcr-2024-263649","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:45:26Z","timestamp":1738802726000},"page":"e263649","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous subdural haematoma secondary to undiagnosed metastatic gastric adenocarcinoma"],"prefix":"10.1136","volume":"18","author":[{"given":"Toshiaki","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Landon","family":"Kozai","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharina","family":"Macapagal","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-7501","authenticated-orcid":false,"given":"Yoshito","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"2025082623381888000_18.2.e263649.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2025082623381888000_18.2.e263649.2","doi-asserted-by":"crossref","DOI":"10.1177\/1533033820964131","article-title":"Prognostic Value of the Site of Distant Metastasis and Surgical Interventions in Metastatic Gastric Cancer: A Population-Based Study","volume":"19","author":"Li","year":"2020","journal-title":"Technol Cancer Res Treat"},{"key":"2025082623381888000_18.2.e263649.3","doi-asserted-by":"crossref","unstructured":"Huang L , Wang L , Shi Y , et al . Brain metastasis from gastric adenocarcinoma: A large comprehensive population-based cohort study on risk factors and prognosis. Front Oncol 2022;12. doi:10.3389\/fonc.2022.897681","DOI":"10.3389\/fonc.2022.897681"},{"key":"2025082623381888000_18.2.e263649.4","first-page":"204","article-title":"Brain-Only Metastasis and 10-Year Survival after Curative Gastric Cancer Resection: A Case Report","volume":"16","author":"Lee","year":"2023","journal-title":"Case Rep Oncol"},{"key":"2025082623381888000_18.2.e263649.5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/s-0042-1749126","article-title":"Metastatic Brain Tumor in the Cerebellopontine Angle from Gastric Cancer: A Case Report","volume":"17","author":"Uchimura","year":"2022","journal-title":"Asian J Neurosurg"},{"key":"2025082623381888000_18.2.e263649.6","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/j.jemermed.2014.04.026","article-title":"Acute spontaneous subdural hematoma in a middle-aged adult: case report and review of the literature","volume":"47","author":"Coombs","year":"2014","journal-title":"J Emerg Med"},{"key":"2025082623381888000_18.2.e263649.7","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/00005053-193408000-00029","article-title":"SUBDURAL FALSE MEMBRANE OR HAEMATOMA (PACHYMENINGITIS INTERNA HAEMORRHAGICA) IN CARCINOMATOSIS AND SARCOMATOSIS OF THE DURA MATER","volume":"80","author":"Russell","year":"1934","journal-title":"J Nerv Ment Dis"},{"key":"2025082623381888000_18.2.e263649.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-003-0020-7"},{"key":"2025082623381888000_18.2.e263649.9","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.12.1713"},{"key":"2025082623381888000_18.2.e263649.10","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3340\/jkns.2011.50.3.274","article-title":"Chronic subdural hematoma after spontaneous intracranial hypotension\u202f: a case treated with epidural blood patch on c1-2","volume":"50","author":"Kim","year":"2011","journal-title":"J Korean Neurosurg Soc"},{"key":"2025082623381888000_18.2.e263649.11","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2023-331166"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263649","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:38:31Z","timestamp":1756276711000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,5]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-263649"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263649","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}