title: Recurrent metastatic hepatocellular carcinoma presenting as consecutive "mirror image" intracerebral haematomas.
abstract: A 34-year old man with a past history of hepatocellular carcinoma (HCC) complained of headache and visual disturbance. Neuroimaging revealed a right occipital haematoma with rim enhancement and at operation, a metastasis from the primary malignancy was found. Five months after surgery and subsequent adjuvant therapy, he presented with blindness. On neuroimaging, a left occipital haematoma was seen. The patient refused surgical intervention. HCC usually has an aggressive clinical course; therefore, recurrent cerebral metastasis is an uncommon clinical problem. "Mirror-image" metastasis, with bleeding in both hemispheres, is rare and has not been reported. We suggest that these metastases occur due to microscopic seeding via an arterial route, and that spread via a venous route, such as occurs through Batson's plexus, is unlikely.
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea.
authors.forename: Dong-Charn
authors.initials: DC
authors.lastname: Cho
authors.forename: Hyeong-Joong
authors.initials: HJ
authors.lastname: Yi
authors.forename: Yong
authors.initials: Y
authors.lastname: Ko
authors.forename: Suck-Jun
authors.initials: SJ
authors.lastname: Oh
authors.forename: Seung-Ro
authors.initials: SR
authors.lastname: Lee
authors.forename: Seung-Sam
authors.initials: SS
authors.lastname: Paik
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012008:Recurrence; D014057:Tomography, X-Ray Computed / Q000379:methods