title: Metastatic hepatocellular carcinoma presenting as epidural hematoma: case report.
abstract: OBJECTIVE
  A case of acutely symptomatic epidural hematoma caused by metastatic hepatocellular carcinoma (HCC) to the cranium is reported. This is a rare case of metastatic HCC without known primary presenting as an epidural hematoma.
  
  
  METHODS
  The patient presented with an acute onset of headache, aphasia, and right hemiparesis 2 weeks after he experienced minor trauma to the cranium. An emergency computed tomographic scan of the head revealed the presence of a left parietal epidural hematoma.
  
  
  METHODS
  An emergency evacuation of the epidural hematoma was performed, and metastatic HCC was diagnosed.
  
  
  CONCLUSIONS
  The patient's neurological deficits were reversed with surgical intervention, and he is now undergoing palliative chemotherapy. This was the first clinical manifestation of HCC in this patient. This case reaffirms the neurosurgeon's role in the complex, multidisciplinary care of patients with craniospinal metastasis.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. mciver.jon@mayo.edu
authors.forename: J I
authors.initials: JI
authors.lastname: McIver
authors.forename: B W
authors.initials: BW
authors.lastname: Scheithauer
authors.forename: C H
authors.initials: CH
authors.lastname: Rydberg
authors.forename: J L
authors.initials: JL
authors.lastname: Atkinson
mesh_terms: D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000556:secondary* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004824:Epidural Space; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed