Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma

Case report

Cien Leong Chye, Kuo Hsuan Lin, Chang Hsien Ou, Cheuk Kwan Sun, I. Wei Chang, Cheng Loong Liang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number60
JournalBMC Surgery
Volume15
Issue number1
DOIs
Publication statusPublished - May 10 2015
Externally publishedYes

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Hematoma, Subdural, Acute
Skull
Hepatocellular Carcinoma
Subdural Hematoma
Neoplasm Metastasis
Tomography
Neoplasms
Hemorrhage
Consciousness
Headache
Hospital Emergency Service
Temporal Bone
Craniotomy
Craniocerebral Trauma
Hematoma
Nausea
Vomiting
Intensive Care Units
Emergencies
Differential Diagnosis

Keywords

  • Hepatocellular carcinoma
  • Metastasis
  • Subdural hematoma

ASJC Scopus subject areas

  • Surgery

Cite this

Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma : Case report. / Chye, Cien Leong; Lin, Kuo Hsuan; Ou, Chang Hsien; Sun, Cheuk Kwan; Chang, I. Wei; Liang, Cheng Loong.

In: BMC Surgery, Vol. 15, No. 1, 60, 10.05.2015.

Research output: Contribution to journalArticle

Chye, Cien Leong ; Lin, Kuo Hsuan ; Ou, Chang Hsien ; Sun, Cheuk Kwan ; Chang, I. Wei ; Liang, Cheng Loong. / Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma : Case report. In: BMC Surgery. 2015 ; Vol. 15, No. 1.
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AB - 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.

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