title: Metastatic choriocarcinoma induced separate simultaneous intracerebral haemorrhages: a very rare occurrence and its novel association with Klinefelter syndrome.
abstract: Non-traumatic separate simultaneous intracerebral haemorrhages (SSIHs) are rare. Relevant aetiologies are diverse and their diagnosis challenging. We report a unique case of SSIH in an 18-year-old male with a background of previously undiagnosed testicular choriocarcinoma and Klinefelter syndrome. The patient was admitted to Auckland City Hospital with headaches, drowsiness and vomiting. A CT scan revealed SSIH in a background of tumorous lesions. His β human chorionic gonadotropin titre was elevated at 355 000 IU/L. The SSIH and the associated tumorous lesions were acutely surgically resected and the patient started on bleomycin, etoposide and cisplatin combination chemotherapy with excellent results. In this article, we underline choriocarcinoma as a rare aetiology of SSIH and present an example of the clinical presentation, investigation and management of this very rare pathological entity.
authors.affiliation: School of Medicine, The University of Auckland, Auckland, New Zealand.
authors.forename: Maximilian Olavi
authors.identifier: http://orcid.org/0000-0001-9290-2703
authors.initials: MO
authors.lastname: Joret
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Robert M
authors.identifier: http://orcid.org/0000-0002-7608-0460
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Scotter
authors.affiliation: Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Heppner
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000556:secondary*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000209:etiology* / Q000473:pathology; D002822:Choriocarcinoma / Q000188:drug therapy / Q000556:secondary*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D006261:Headache / Q000209:etiology; D006801:Humans; D007713:Klinefelter Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D010349:Patient Compliance; D012894:Sleep Stages; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology*; D014839:Vomiting / Q000209:etiology
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin