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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

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

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Cien-Leong Chye, Kuo-Hsuan Lin, Chang-Hsien Ou, Cheuk-Kwan Sun, I-Wei Chang, Cheng-Loong Liang
Wichtige Hinweise

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.

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.
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