title: Unexpected intraparenchymal hematoma caused by brain metastasis in a patient with neuroblastoma: case report.
abstract: A 2-year-old girl who had previously been treated for stage IV intra-abdominal neuroblastoma presented with headache and vomiting. Computed tomography (CT) showed hematoma in the right temporal lobe. Two months previously, she had suffered a generalized seizure but brain CT was unremarkable. The hematoma was removed completely without evidence of vascular anomaly or tumor. Four weeks after surgery, magnetic resonance imaging with gadolinium showed a developing mass lesion in the hematoma bed. A second operation for tumor removal confirmed the rare diagnosis of intraparenchymal metastasis. Metastatic neuroblastoma to the central nervous system (CNS) occasionally can cause massive hemorrhage. Therefore, early detection of CNS metastasis can be important. The related factors in this patient with abdominal neuroblastoma included elevated serum lactate dehydrogenase, N-myc gene amplification, and coexisting orbital metastasis, which all occurred within 22 months from initial diagnosis. The median interval from diagnosis of the primary tumor to diagnosis of CNS metastasis in neuroblastoma is 12-22 months, which indicates relatively late metastasis presentation. The initial presentation of this late metastasis is hemorrhage that can have sudden detrimental consequences, so a patient with neuroblastoma must be followed up carefully, particularly if elevated serum lactate dehydrogenase, orbital metastasis, N-myc gene amplification, or clinical symptoms are present, even if brain CT is unremarkable. The understanding that intraparenchymal hematoma can occur prior to detectable CNS metastasis may be important for early detection of this life-threatening condition.
authors: Department of Neurosurgery, Juntendo University School of Medicine, Tokyo. hohkura@junetendo.ac.jp
authors: Hidehiro
authors: H
authors: Okura
authors: Kenji
authors: K
authors: Yatomi
authors: Youhei
authors: Y
authors: Saito
authors: Chinatsu
authors: C
authors: Kasuga
authors: Hisato
authors: H
authors: Ishii
authors: Kostadin
authors: K
authors: Karagiozov
authors: Masakazu
authors: M
authors: Miyajima
authors: Hajime
authors: H
authors: Arai
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000556:secondary*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology; D009447:Neuroblastoma / Q000150:complications / Q000556:secondary* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D013702:Temporal Lobe / Q000098:blood supply / Q000473:pathology*; D016896:Treatment Outcome