Recurrent metastatic hepatocellular carcinoma presenting as consecutive "mirror image" intracerebral haematomas.
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.
Cho
Dong-Charn
DC
Department of Neurosurgery, Hanyang University Medical Center, Seoul, Republic of Korea.
Yi
Hyeong-Joong
HJ
Ko
Yong
Y
Oh
Suck-Jun
SJ
Lee
Seung-Ro
SR
Paik
Seung-Sam
SS
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