Abstract
BackgroundSkull 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 presentationA 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.ConclusionPatients 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.
Highlights
Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported
Patients with acute subdural hematoma (SDH) without a history of head injury are rarely encountered in the emergency department (ED)
Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH
Summary
Acute spontaneous SDH in patients without a history of head injury is rarely encountered. Metastatic carcinoma with a tumor bleeding should be included in the differential diagnosis for patients presenting with spontaneous SDH. Consent Written informed consent was obtained from the patient’s son for publication of this case report and any accompanying imagines. A copy of the written consent is available for review by the Editor of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions LCL and CCL performed the surgery and drafted the manuscript; LKH and SCK conducted a literature search and drafted the manuscript; OCH participated in the acquisition and interpretation of radiological data. LCL supervised the draft and care the patient’s follow-up. CIW participated in the preparation and interpretation of pathological data. All authors read and approved the final manuscript
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