1
|
Ahn KH, Ryu HS, Han MS, Choi YD, Joo SP. Spontaneous Acute Epidural Hematoma Associated With Metastatic Hepatocellular Carcinoma: A Case Report. Korean J Neurotrauma 2023; 19:384-392. [PMID: 37840619 PMCID: PMC10567519 DOI: 10.13004/kjnt.2023.19.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Spontaneous acute epidural hematoma (AEDH) co-occurring with metastatic hepatocellular carcinoma (HCC) of the skull is rare, with only 7 documented cases in existing literature. This report describes the case of a 42-year-old man who presented with decreased consciousness following intermittent headaches following minor head trauma. Computed tomography imaging revealed an AEDH, prompting surgical intervention. Despite preliminary assumptions linking the causes of the trauma, surgical exploration revealed no evidence of traumatic injury. Instead, an infiltrative soft-tissue mass within the skull was identified. Histopathological examination confirmed that the mass was a metastatic HCC. Despite the successful hematoma evacuation, the patient's neurological status did not improve. This case underscores the importance of considering metastatic disease in the differential diagnosis of AEDH, particularly in patients with a history of malignant tumors, irrespective of prior indications of bone metastasis. Furthermore, it emphasizes the need to enhance diagnostic and therapeutic strategies for such complex cases.
Collapse
Affiliation(s)
- Kang hee Ahn
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Han Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| |
Collapse
|
2
|
Xu M, Xue Y, Chao X, Chen Z, Wang Y, Huo X, Ji X, Wang H. Cryptogenic recurrent spontaneous intracranial epidural hematoma: A case report and literature review. Front Neurol 2023; 14:1123108. [PMID: 37006487 PMCID: PMC10060842 DOI: 10.3389/fneur.2023.1123108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundSpontaneous epidural hematoma (EDH) has been suggested to be associated with adjacent infective pathologies, dural vascular malformations, extradural metastases, or coagulopathies. Cryptogenic spontaneous EDH is extremely rare.Case presentationThe present study reports the case of a cryptogenic spontaneous EDH in a young woman following sexual intercourse. She was diagnosed with consecutive EDH at three different sites within a short time. After three timely operations, a satisfactory outcome was achieved.ConclusionEDH should be investigated when a young patient develops headaches and shows signs of increased ICP after emotional hyperactivity or hyperventilation. If early diagnosis and surgical decompression can be carried out in time, the prognosis would be satisfactory.
Collapse
Affiliation(s)
- Min Xu
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Ya Xue
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Xiaofeng Chao
- Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhenglou Chen
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Yunjiang Wang
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Xuqi Huo
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Xiang Ji
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
| | - Hongshen Wang
- Department of Neurosurgery, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
- Department of Neurosurgery, The Affiliated Yancheng Hospital of Southeast University, Yancheng, Jiangsu, China
- *Correspondence: Hongshen Wang
| |
Collapse
|
3
|
Siahaan AMP, Tandean S, Nainggolan BWM. Spontaneous epidural hematoma induced by rivaroxaban: A case report and review of the literature. Surg Neurol Int 2022; 13:420. [PMID: 36324933 PMCID: PMC9610455 DOI: 10.25259/sni_608_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Trauma is the most frequent reason for epidural bleeding. However, numerous investigation had discovered that anticoagulants such as rivaroxaban could cause epidural hematoma. Here, we present a case of epidural hematoma in young man who got rivaroxaban as treatment of deep vein thrombosis. Case Description: A 27-year-old male with a history of deep vein thrombosis and one month of rivaroxaban medication presented with seizure and loss of consciousness following a severe headache. A CT scan of the head revealed epidural bleeding, and emergency blood clot removal was performed. As a reversal, prothrombin complex was utilized. Conclusion: Rivaroxaban has the potential to cause an epidural hemorrhage. Reversal anticoagulant should be administered before doing emergency surgery.
Collapse
Affiliation(s)
| | - Steven Tandean
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | | |
Collapse
|
4
|
Sinovenous outflow in lateral sinus dural arteriovenous fistulas after stereotactic radiosurgery: a retrospective longitudinal imaging study. Acta Neurochir (Wien) 2022; 164:2409-2418. [PMID: 35831724 DOI: 10.1007/s00701-022-05310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate sinovenous outflow restriction (SOR) in lateral sinus dural arteriovenous fistulas (LSDAVFs) after Gamma Knife radiosurgery (GKRS) and its association with complete obliteration. METHODS We retrospectively (1995-2019) enrolled 39 patients with LSDAVFs who had undergone GKRS alone and evaluated their angiography and magnetic resonance imaging (MRI) before and after GKRS. The LS conduits ipsilateral and contralateral to the DAVFs were scored using a 5-point scoring system, with scores ranging from 0 (total occlusion) to 4 (fully patent). SOR was defined by a conduit score < 2. Demographics, imaging features, and outcomes were compared between patients with and without ipsilateral SOR after GKRS. Logistic regression analysis was performed to estimate the odds ratio (OR) for obliteration with the imaging findings. RESULTS After a median angiographic follow-up of 28 months for the 39 patients, the ipsilateral LS became more restrictive (median conduit score before and after GKRS: 2 vs. 1, p = .011). Twenty-one patients with ipsilateral SOR after GKRS had a significantly lower obliteration rate (52.4% vs. 94.4%, p = .005) than those without SOR. Follow-up SOR was independently associated with a lower obliteration rate (OR 0.05, p = .017) after adjustment for age, cortical venous reflux, and absent sinus flow void on MRI. CONCLUSION This study demonstrates a restrictive change of outflow in LSDAVFs after GKRS and a lower obliteration rate in patients with SOR. Follow-up imaging for SOR may help predict outcomes of these patients.
Collapse
|
5
|
Lv GZ, Li GC, Tang WT, Zhou D, Yang Y. Spontaneous acute epidural hematoma secondary to skull and dural metastasis of hepatocellular carcinoma: A case report. World J Clin Cases 2022; 10:8728-8734. [PMID: 36157807 PMCID: PMC9453350 DOI: 10.12998/wjcc.v10.i24.8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/12/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The skull and dura are uncommon sites for the metastasis of hepatocellular carcinoma (HCC). Spontaneous acute epidural hematoma (AEDH) is also very rare. We report here a spontaneous AEDH secondary to skull and dural metastasis of HCC. This case is extremely rare.
CASE SUMMARY A 48-year-old male patient with a history of HCC developed unconsciousness spontaneously. Head computed tomography showed "a huge AEDH in the left parietal and occipital region with osteolytic destruction of the left parietal bone. Emergent operation was performed to evacuate the hematoma and resect the lesion. Pathological study revealed that the lesion was the metastases from HCC. The patient died of lung infection, anemia, and liver failure 3 wk after operation.
CONCLUSION Spontaneous AEDH caused by hepatocellular carcinoma (HCC) dural and skull metastases is extremely rare, the outcome is poor. So, early diagnosis is important. If the level of AFP does not decrease with the shrinkage of intrahepatic lesions after treatment, it is necessary to be alert to the existence of extrahepatic metastases. Since most of the patients had scalp and bone masses, physicians should pay attention to the patient's head palpation. Once a patient with the history of HCC had sudden neurological dysfunction, the possibility of spontaneous AEDH caused by the skull and dura mater metastases should be considered. Since hemorrhage is common in the skull HCC metastases, for patients with spontaneous AEDH accompanied by skull osteolytic lesions, it is also necessary to be alert to the possibility of HCC. For AEDH secondary to HCC metastases, early diagnosis and timely treatment are critical to improve the patients’ outcomes.
Collapse
Affiliation(s)
- Guang-Zhao Lv
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Guo-Chao Li
- Department of Neurosurgery, Luoding People’s Hospital, Yunfu 527200, Guangdong Province, China
| | - Wei-Tai Tang
- Department of Neurosurgery, Luoding People’s Hospital, Yunfu 527200, Guangdong Province, China
| | - Dong Zhou
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Yong Yang
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| |
Collapse
|
6
|
Can spontaneous bifrontal extradural haematoma be a sole presentation in previously undiagnosed sickle cell disease? A rare case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Sun CH, Tsai MY, Huang WH, Liao CH. Solitary skull metastasis mimicking a meningioma with dural tail sign as the initial presentation of hepatocellular carcinoma: A case report and a brief review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
8
|
Zhao C, Wei Y, Liu J, Xu S, Jiang X, Di G. Spontaneous acute epidural hematoma associated with chronic subdural hematoma due to dural metastasis of gastric carcinoma: a case report and literature review. Int J Neurosci 2020; 131:405-410. [PMID: 32186217 DOI: 10.1080/00207454.2020.1744599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Non-traumatic spontaneous acute epidural hematoma (EDH) happening to chronic subdural hematoma (SDH) caused by dural metastases is a rare entity. Pathogenesis can be derived from infection, coagulopathy, and inflammation. Malignant tumors metastasize to dura mater is one of the most infrequent causes. The exact mechanism remains elusive in spite of several possible speculations. The clinical manifestations, management and outcomes vary among reported cases.Case Description: A 45-year-old woman without history of trauma presented with headache, vomiting and disturbance of consciousness and developed brain hernia rapidly. On arival, she has lost into coma with Glasgow coma scale (GCS) score 5, bilateral pupils were not equal, with disappeared reflectance. Emergency imaging prompted large acute EDH, combined with SDH, arising from dural granular neoplasm confirmed intraoperatively. Four days after surgery, the bilateral pupils were equal in size and sensitive to light reflection.Conclusion: Dural metastases can cause EDH, chronic SDH can also be resulted from metastatic tumors of dura mater. When dealing with spontaneous non-traumatic hematoma around the dura mater, to make the precise diagnosis is sometimes doubtful and confusing. The stream of diagnostic thinking should be opened, including medical diseases such as liver and kidney disease, drug history, history of cancer and other possible clues. Thus, a detailed and purposeful systematic medical history review and physical examination is important in order to make more appropriate strategies for the clinic.
Collapse
Affiliation(s)
- Chenhui Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yi Wei
- Department of Hepatobiliary Surgery, The First People's Hospital of Jining, Jining, China
| | - Jie Liu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shanshui Xu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Guangfu Di
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| |
Collapse
|
9
|
Superior Sagittal Sinus Tumor Eroding through the Skull: An Unfamiliar Presentation of Hepatocellular Carcinoma and Literature Review. Case Rep Surg 2019; 2019:5945726. [PMID: 31781465 PMCID: PMC6875341 DOI: 10.1155/2019/5945726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/28/2019] [Indexed: 01/10/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) most commonly develops in patients with liver cirrhosis caused by hepatitis C and B virus. HCC is the most common cause of death in people with cirrhosis. The lungs, bone, and lymph nodes are frequent sites of metastasis of HCC. Patients and Methods We present a case of solitary skull metastasis as the first symptom of HCC. A literature review with regard to HCC skull metastasis was undertaken. Results This patient had HCC based on chronic hepatitis C. He presented with an erosive lesion masquerading as a scalp lipoma resulting in hepatocellular carcinoma with retrograde reflux and sinus metastases. The lesion was ultimately resected, but the patient died within one week from liver failure. Seventeen similar cases were found in the literature. Median age of the patients was 58 years with 95% being male and 35% having viral hepatitis. Surgery was the preferred treatment with chemotherapy and radiation being other options. Outcome was acceptable but baseline liver disease is a limiting factor. Discussion Cranial metastases of HCC are rare but should be considered in patients with chronic hepatitis C presenting with scalp skin lesions.
Collapse
|
10
|
Delgado Maroto A, Del Moral Martínez M, Diéguez Castillo C, Casado Caballero FJ. Acute epidural haematoma as a presentation of hepatocellular carcinoma: Case report and literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:177-179. [PMID: 29779760 DOI: 10.1016/j.gastrohep.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Ana Delgado Maroto
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario San Cecilio, Granada, España.
| | | | | | | |
Collapse
|
11
|
Harrison RA, Nam JY, Weathers SP, DeMonte F. Intracranial dural, calvarial, and skull base metastases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:205-225. [PMID: 29307354 DOI: 10.1016/b978-0-12-811161-1.00014-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Metastatic disease to the intracranial dura, the calvarium, and the skull base is relatively uncommon but presents unique diagnostic and management challenges in the patient with cancer. Modern imaging techniques have facilitated the detection of intracranial tumor deposits, leading to increased incidence. While dural and calvarial metastases often present with nonspecific symptoms, skull base metastases present with distinct clinical syndromes dependent on the local neurovascular structures affected. Intracranial dural metastases can often be confused with meningioma and pose a diagnostic challenge, as well as significant neurologic morbidity, especially in the setting of hemorrhage. Surgical intervention may be helpful in selected patients for symptomatic relief as well as survival benefit. Management paradigms need to take into account the relative risks, benefits, and likely outcomes for each possible modality of treatment. Surgical excision is useful in many patients and in combination with radiation therapy can provide significant palliation. While medical therapy is rarely an initial therapy in these entities, it may be of added benefit dependent on the underlying tumor histology and prior treatment history. Occasionally treatment with curative intent is justified.
Collapse
Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Joo Yeon Nam
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Franco DeMonte
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States.
| |
Collapse
|
12
|
Reappraisal of the causes of spontaneous epidural hematomas: A case after stent-assisted coiling for ruptured posterior communicating artery aneurysm. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
13
|
Sartori Balbinot R, Facco Muscope AL, Dal Castel M, Sartori Balbinot S, Angelo Balbinot R, Soldera J. Intraparenchymal Hemorrhage due to Brain Metastasis of Hepatocellular Carcinoma. Case Rep Gastroenterol 2017; 11:516-525. [PMID: 29033772 PMCID: PMC5637007 DOI: 10.1159/000479221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023] Open
Abstract
Although extrahepatic metastases from hepatocellular carcinoma (HCC) are present in only 5–15% of cases, they are certainly factors associated with poor prognosis. The main sites include lung, lymph nodes, bones, and adrenal glands, in descending order. Metastasis in the central nervous system is extremely rare, and the incidences vary from 0.6 to 1.7%. We report a case of a 54-year-old man previously diagnosed with alcohol-induced cirrhosis of the liver and HCC. The patient was admitted presenting progressive left hemiparesis and headache which started 2 days earlier, with no history of cranioencephalic trauma. After admission, cranial computed tomography revealed an intraparenchymal hemorrhage area with surrounding edema in the right frontal lobe. An angioresonance requested showed a large extra-axial mass lesion located in the right frontal region with well-defined contours and predominantly hypointense signal on T2 sequence. At first, the radiological findings suggested meningioma as the first diagnostic hypothesis. However, the patient underwent surgery. The tumor was completely removed, and the morphological and immunohistochemical findings were consistent with metastatic hepatocarcinoma associated with meningioma. In postoperative care, the patient did not recover from the left hemiparesis and manifested Broca's aphasia. He had a survival time of 24 weeks, presenting acute liver failure as his cause of death. There is a lack of evidence supporting a specific management of patients with brain metastasis from HCC. Furthermore, there are no studies that evaluate different modalities of therapeutics in brain metastasis of HCC due to the rarity of this condition. Therefore, management must be individualized depending on probable prognostic factors in these patients.
Collapse
Affiliation(s)
| | | | - Mateus Dal Castel
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Silvana Sartori Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Raul Angelo Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Jonathan Soldera
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
14
|
Kim YS, Moon KS, Lee KH, Jung TY, Jang WY, Kim IY, Jung S. Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature. Oncol Lett 2016; 11:741-744. [PMID: 26870277 DOI: 10.3892/ol.2015.3947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 10/23/2015] [Indexed: 01/30/2023] Open
Abstract
Acute epidural hematoma (AEDH) is one of the most common pathological types of head trauma, and may develop without an accidental event, although this is uncommon. The present study reports the case of a 41-year-old male patient that developed spontaneous AEDH due to skull metastasis of hepatocellular carcinoma (HCC). The man was admitted to Chonnam National University Hwasun Hospital and Medical School due to drowsiness and right-sided hemiparesis. A computed tomography scan of the head revealed the presence of a large AEDH and a lytic bone lesion in the left posterior fossa and parieto-occipital region, which exhibited heterogeneous enhancement. The perioperative findings revealed a large amount of mixed-stage epidural hematoma and a soft hemorrhagic mass that exhibited lytic change on the occipital bone. No evidence of head trauma, such as skull fracture or scalp contusion, was detected. The pathological diagnosis was hematoma with metastatic HCC. The current study reports the rare case of a patient with a metastatic tumor located in the skull that resulted in the development of spontaneous AEDH. Once a sudden and unpredicted neurological deficit occurs in a patient with HCC that is also diagnosed with skull metastasis, the possibility of spontaneous AEDH developing from the metastasis should be considered.
Collapse
Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| |
Collapse
|
15
|
Chye CL, Lin KH, Ou CH, Sun CK, Chang IW, Liang CL. Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma: case report. BMC Surg 2015; 15:60. [PMID: 25958386 PMCID: PMC4432998 DOI: 10.1186/s12893-015-0045-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/04/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported. A skull metastasis of HCC with a tumor bleeding resulting in spontaneous subdural hematoma (SDH) is extremely unusual. We report the first case of acute spontaneous SDH in a 69-year-old woman who presented with acute onset of headache, because of tumor bleeding caused by skull metastasis of HCC. CASE PRESENTATION A 69-year-old woman was referred to our hospital because of progressive headache, nausea, and vomiting for 3 days. Brain computed tomography (CT) performed in the emergency department (ED) revealed a left temporal SDH with a slight mass effect and a small left temporal bone erosion. Tri-phasic abdominal CT demonstrated a large right lobe liver tumor compatible with HCC. She experienced progressive deterioration of consciousness in the intensive care unit. Follow-up CT showed an enlargement of the SDH. An emergency craniotomy for hematoma evacuation and removal of skull tumor was performed. She regained consciousness and had no neurological deficits during the postoperative course. Pathological examination of the skull specimen indicated metastasis of a HCC. CONCLUSION Patients with acute SDH without a history of head injury are rarely encountered in the ED. Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH. Before an operation for SDH, the possibility of metastatic lesion of the skull should be considered in the surgical planning and the origin of malignancy should be sought.
Collapse
Affiliation(s)
- Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan
| | - Kuo-Hsuan Lin
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chang-Hsien Ou
- Department of Diagnostic Radiology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan.
| |
Collapse
|
16
|
Jang SY, Kim CH, Cheong JH, Kim JM. Concomitant Subdural Hemorrhage and Intracerebral Hemorrhage due to Brain Metastasis of the Hepatocellular Carcinoma. Brain Tumor Res Treat 2015; 3:48-51. [PMID: 25977908 PMCID: PMC4426278 DOI: 10.14791/btrt.2015.3.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/06/2014] [Accepted: 12/17/2014] [Indexed: 01/30/2023] Open
Abstract
Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0×3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.
Collapse
Affiliation(s)
- Se Youn Jang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| |
Collapse
|
17
|
Chen CY, Zhong JH, Liu JL. Retrobulbar metastasis and intracranial invasion from postoperative hepatocellular carcinoma: A case report and review of the literature. Oncol Lett 2014; 9:721-726. [PMID: 25624898 PMCID: PMC4301548 DOI: 10.3892/ol.2014.2733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/06/2014] [Indexed: 12/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common malignant cancer of the liver and the third ranking cause of cancer-related mortality worldwide. Following the diagnosis of HCC, intrahepatic and extrahepatic metastasis patients account for ~50–75% of all HCC cases, lung and regional lymph nodes metastasis are the most common; metastasis to bone, skin and adrenal glands are rare, orbit metastasis and intracranial invasion are extremely rare. The present study reports the rare case of a patient with HCC that metastasized to the head. The patient presented with retrobulbar and intracranial invasion, and sub-scalp extension. Based on imaging findings, the lesion was initially misdiagnosed as meningioma, however, postoperative pathological examinations resulted in a definitive diagnosis of HCC metastasis. Based on the present case and a review of the relevant literature published since 2009, the current study recommends that metastasis must be considered when diagnosing retrobulbar head lesions in patients with HCC, regardless of contradictory imaging findings and other clinical indicators, which may closely mimic the original head lesion.
Collapse
Affiliation(s)
- Chun-Yong Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, The Affiliated Tumor Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jing-Li Liu
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| |
Collapse
|
18
|
Chen CY, Zhong JH, Liu JL. Retrobulbar metastasis and intracranial invasion from postoperative hepatocellular carcinoma: A case report and review of the literature. Oncol Lett 2014. [PMID: 25624898 DOI: 10.3892/ol] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common malignant cancer of the liver and the third ranking cause of cancer-related mortality worldwide. Following the diagnosis of HCC, intrahepatic and extrahepatic metastasis patients account for ~50-75% of all HCC cases, lung and regional lymph nodes metastasis are the most common; metastasis to bone, skin and adrenal glands are rare, orbit metastasis and intracranial invasion are extremely rare. The present study reports the rare case of a patient with HCC that metastasized to the head. The patient presented with retrobulbar and intracranial invasion, and sub-scalp extension. Based on imaging findings, the lesion was initially misdiagnosed as meningioma, however, postoperative pathological examinations resulted in a definitive diagnosis of HCC metastasis. Based on the present case and a review of the relevant literature published since 2009, the current study recommends that metastasis must be considered when diagnosing retrobulbar head lesions in patients with HCC, regardless of contradictory imaging findings and other clinical indicators, which may closely mimic the original head lesion.
Collapse
Affiliation(s)
- Chun-Yong Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, The Affiliated Tumor Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jing-Li Liu
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| |
Collapse
|
19
|
Kumar PM, Manisha M. Epidural hematoma secondary to solitary skull metastasis from an ovarian carcinoma. Asian J Neurosurg 2014; 9:112-4. [PMID: 25126131 PMCID: PMC4129576 DOI: 10.4103/1793-5482.136729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report a rare case of an acute epidural hematoma (EDH) due to solitary skull metastasis in a 60-year-old patient treated earlier for ovarian carcinoma. The patient presented with head injury followed by unconsciousness and computerized tomography showed a large EDH in the right parietal region along with a contusion of left temporal-parietal lobe and subarachnoid hemorrhage in left sylvian fissure. Emergency craniotomy and evacuation of the EDH was performed and the hemorrhage was determined to be secondary to skull metastasis of ovarian carcinoma; the patient recovered and received whole brain radiation therapy.
Collapse
Affiliation(s)
- P M Kumar
- Department of Neurosurgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - M Manisha
- Department of Pathology, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| |
Collapse
|
20
|
Mahore A, Ramdasi RV, Pauranik A, Epari S. Tumour bleed manifesting as spontaneous extradural haematoma in posterior fossa. BMJ Case Rep 2014; 2014:bcr-2014-205175. [PMID: 25008340 DOI: 10.1136/bcr-2014-205175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a unique case of primary extradural angiosarcoma of posterior fossa manifesting as extradural haematoma in a 12-year-old boy who presented with acute onset headache, vomiting, nuchal rigidity and altered sensorium. The patient underwent a retromastoid suboccipital craniotomy on emergency basis, and the lesion was excised completely. Histopathology and immunohistochemistry revealed an angiosarcoma, following which radiation therapy was given. The patient showed complete clinical and neurological improvement. At a follow-up of 2 years he is in good health without any sign of regrowth.
Collapse
Affiliation(s)
- Amit Mahore
- Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | | | - Anvita Pauranik
- Department of Radiology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Shridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
21
|
Chang CH, Chen CC, Tsai IT, Sun CK, Liang CL, Chang HC. Subdural hemorrhage from a hepatoma due to metastasis. J Acute Med 2013. [DOI: 10.1016/j.jacme.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Babatola BO, Salman YA, Abiola AM, Okezie KO, Oladele AS. Spontaneous epidural haematoma in sickle cell anaemia: case report and literature review. J Surg Tech Case Rep 2013; 4:135-7. [PMID: 23741596 PMCID: PMC3673360 DOI: 10.4103/2006-8808.110271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Non traumatic spontaneous epidural Haematoma is a rare and often unmentioned complication of sickle cell disease. It is often associated with skull bone infarction. We report an eighteen year old boy with sickle cell anaemia who developed persistence headache during a vaso-occlusive crisis. Brain computed tomography (CT) revealed a right frontal epidural Haematoma (EDH) compressing on the brain. No other etiologic factor was identified. A right frontal craniotomy and evacuation of the Haematoma was performed and he made good recovery. The possible pathogeneses of this rare condition are discussed.
Collapse
Affiliation(s)
- Bankole O Babatola
- Department of Surgery, Neurosurgery Unit, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | | | | | | | | |
Collapse
|