title: Skull metastasis of hepatocellular carcinoma associated with acute epidural hematoma: a case report.
abstract: BACKGROUND
  Although epidural hematoma is well documented in trauma patients, its association with other etiologies, such as neoplasms, is not widely known. Here the authors report a case of acute epidural hematoma that originated from a metastatic hepatocellular carcinoma (HCC) in the skull.
  
  
  METHODS
  A 70-year-old male was admitted to our hospital with left-sided hemiparesis. Preoperative computed tomography (CT) revealed a lenticular high-density area adjacent to the right parietal bone, consistent with an acute epidural hematoma. A subsequent magnetic resonance image (MRI) showed a skull tumor adjacent to the epidural hematoma. Removal of the tumor and evacuation of the hematoma were performed and the pathological diagnosis was metastatic HCC. Postoperatively, the patient gradually recovered but he died of pneumonia 2 months later.
  
  
  CONCLUSIONS
  This report represents an additional example of a rare case of metastatic skull tumor associated with acute epidural hematoma. The authors suggest that metastatic skull tumors may be one of the important differential diagnoses in patients with acute epidural hematoma.
authors.affiliation: Department of Neurosurgery, Juzenkai Hospital, Nagasaki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.forename: M
authors.initials: M
authors.lastname: Kurihara
authors.forename: M
authors.initials: M
authors.lastname: Daikoku
authors.forename: G
authors.initials: G
authors.lastname: Kitange
authors.forename: S
authors.initials: S
authors.lastname: Shibata
mesh_terms: D000208:Acute Disease; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology*; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000601:surgery; D010294:Parietal Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010296:Parietal Lobe / Q000473:pathology* / Q000601:surgery; D012888:Skull Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed