{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:31:53Z","timestamp":1787142713761,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Skull metastases usually arise from breast and lung primaries and are often silent. Spread from periampullary carcinoma is exceedingly rare. We present a 46-year-old female with a history of periampullary carcinoma, previously treated with surgery and chemotherapy, who presented with headache, vomiting, and declining consciousness. At admission, she was in a stuporous state. Computed tomography (CT) revealed a large right frontoparietal subdural hematoma (SDH) with midline shift. Emergency burr hole evacuation exposed fragile bone and hemorrhagic tissue; biopsy confirmed metastatic adenocarcinoma. Retrospective review of bone windows revealed lytic lesions consistent with skull metastasis. This appears to be the first documented case of periampullary carcinoma metastasizing to the skull and presenting as spontaneous SDH, without trauma, coagulopathy, or anticoagulant use. Early recognition with magnetic resonance imaging and positron emission tomography-CT is vital. This case highlights the importance of considering skull metastasis as an etiology of intracranial hemorrhage in oncologic patients.<\/jats:p>","DOI":"10.4103\/aam.aam_595_25","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:00:25Z","timestamp":1766397625000},"page":"S90-S92","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Periampullary Carcinoma Presenting as Chronic Subdural Hematoma: A Rare Case Report"],"prefix":"10.4103","volume":"25","author":[{"given":"Prashant M.","family":"Punia","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish P.","family":"Chugh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarang S.","family":"Gotecha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag S.","family":"Singhal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant A.","family":"Gaud","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishant Shekhar","family":"Rege","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"R1-20260819","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/BF02893397","article-title":"Unusual case of skull metastasis secondary to pancreatic adenocarcinoma","volume":"11","author":"Aydin","year":"2005","journal-title":"Pathol Oncol Res"},{"key":"R2-20260819","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1023\/B:NEON.0000021775.60688.2d","article-title":"Skull metastasis from ampulla of Vater adenocarcinoma: Case report","volume":"67","author":"Jeon","year":"2004","journal-title":"J Neurooncol"},{"issue":"Suppl 5(Suppl 5)","key":"R3-20260819","first-page":"v1","article-title":"Pancreatric Section, British Society of Gastroenterology; Pancreatic Society of Great Britain and Ireland; Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of Pathologists; Special Interest Group for Gastro-Intestinal Radiology. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas","volume":"54","year":"2005","journal-title":"Gut"},{"key":"R5-20260819","first-page":"53","article-title":"The cerebrospinal venous system: Anatomy, physiology, and clinical implications","volume":"8","author":"Tobinick","year":"2006","journal-title":"MedGenMed"},{"key":"R6-20260819","doi-asserted-by":"crossref","first-page":"166","DOI":"10.3340\/jkns.2010.48.2.166","article-title":"Spontaneous intracranial epidural hematoma originating from dural metastasis of hepatocellular carcinoma","volume":"48","author":"Kim","year":"2010","journal-title":"J Korean Neurosurg Soc"},{"key":"R7-20260819","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12893-015-0045-x","article-title":"Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma: case report","volume":"15","author":"Chye","year":"2015","journal-title":"BMC Surg"},{"key":"R8-20260819","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s11060-010-0465-5","article-title":"Metastatic skull tumors: MRI features and a new conventional classification","volume":"104","author":"Mitsuya","year":"2011","journal-title":"J Neurooncol"},{"key":"R9-20260819","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1148\/130.2.465","article-title":"Radiation therapy for metastases to the base of the skull","volume":"130","author":"Vikram","year":"1979","journal-title":"Radiology"},{"key":"R10-20260819","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/cncr.20308","article-title":"Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial","volume":"100","author":"Rosen","year":"2004","journal-title":"Cancer"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_595_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:01:43Z","timestamp":1787140903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_595_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":9,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_595_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]},"assertion":[{"value":"2025-10-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}