title: Bulbar Paralysis and Facial Paralysis due to Metastatic Hepatocellular Carcinoma: A Case Report and Literature Review.
abstract: Skull-base metastasis (SBM) from hepatocellular carcinoma (HCC) is extremely rare, and multiple cranial nerve paralysis due to SBM from HCC is also rare. We report a case of bulbar and facial paralysis due to SBM from HCC. A 46-year-old Chinese man presented with a hepatic right lobe lesion that was detected during a routine physical examination. After several failed attempts to treat the primary tumor and bone metastases, neurological examination revealed left VII, IX, X, and XI cranial nerve paralysis. Computed tomography of the skull base subsequently revealed a large mass that had destroyed the left occipital and temporal bones and invaded the adjacent structure. After radiotherapy (27 Gy, 9 fractions), the patient experienced relief from his pain, and the cranial nerve dysfunction regressed. However, the patient ultimately died, due to the tumor's progression. Radiotherapy is usually the best option to relieve pain and achieve regression of cranial nerve dysfunction in cases of SBM from HCC, although early treatment is needed to achieve optimal outcomes. The present case helps expand our understanding regarding this rare metastatic pathway and indicates that improved awareness of SBM in clinical practice can help facilitate timely and appropriate treatment.
authors.affiliation: From the Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street (ML, BL, QW, SY, LD); Department of Radiation Oncology, Tumor Hospital of Jilin Province, 1018 Huguang Road (SL); Department of Hand Surgery (BL); Department of Pathology (LG); and Department of Cancer Center, The First Hospital, Jilin University, 71 Xinmin Street, Changchun, China (XW).
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.forename: Shixin
authors.initials: S
authors.lastname: Liu
authors.forename: Bailong
authors.initials: B
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Liang
authors.initials: L
authors.lastname: Guo
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Shuo
authors.initials: S
authors.lastname: Yang
authors.forename: Lihua
authors.initials: L
authors.lastname: Dong
mesh_terms: D001859:Bone Neoplasms / Q000150:complications* / Q000532:radiotherapy / Q000556:secondary; D010244:Bulbar Palsy, Progressive / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000556:secondary; D005158:Facial Paralysis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone; D013701:Temporal Bone
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