Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma: case report

BMC Surgery

Cheng-Loong Liang¹  I-Wei Chang²  Cheuk-Kwan Sun⁴  Chang-Hsien Ou³  Kuo-Hsuan Lin⁴  Cien-Leong Chye¹ 

[1] Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, Kaohsiung City, 824, Taiwan;Department of Pathology, E-Da Hospital, Kaohsiung, Taiwan;Department of Diagnostic Radiology, E-Da Hospital, Kaohsiung, Taiwan;Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan

关键词: Subdural hematoma;    Metastasis;    Hepatocellular carcinoma;   

Others  :  1204296
DOI  :  10.1186/s12893-015-0045-x

 received in 2014-10-31, accepted in 2015-05-04,  发布年份 2015

【 摘 要 】

Background

Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported. A skull metastasis of HCC with a tumor bleeding resulting in spontaneous subdural hematoma (SDH) is extremely unusual. We report the first case of acute spontaneous SDH in a 69-year-old woman who presented with acute onset of headache, because of tumor bleeding caused by skull metastasis of HCC.

Case presentation

A 69-year-old woman was referred to our hospital because of progressive headache, nausea, and vomiting for 3 days. Brain computed tomography (CT) performed in the emergency department (ED) revealed a left temporal SDH with a slight mass effect and a small left temporal bone erosion. Tri-phasic abdominal CT demonstrated a large right lobe liver tumor compatible with HCC. She experienced progressive deterioration of consciousness in the intensive care unit. Follow-up CT showed an enlargement of the SDH. An emergency craniotomy for hematoma evacuation and removal of skull tumor was performed. She regained consciousness and had no neurological deficits during the postoperative course. Pathological examination of the skull specimen indicated metastasis of a HCC.

Conclusion

Patients with acute SDH without a history of head injury are rarely encountered in the ED. Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH. Before an operation for SDH, the possibility of metastatic lesion of the skull should be considered in the surgical planning and the origin of malignancy should be sought.

【 授权许可】

   
2015 Chye et al.; licensee BioMed Central.

【 图 表 】

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