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

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.

Subdural hematoma due to skull base bone metastasis of epidermal growth factor receptor mutated non‐small cell lung cancer

“…Skull base bone metastases are thought to invade directly via the thin dura mater, leading to subdural hematomas when intratumoral hemorrhage occurs. 2 Coagulopathy, especially disseminated intravascular coagulation, can complicate cases of subdural hematoma associated with dural metastases, but this case did not present with coagulopathy. 3 Adenocarcinoma cells were detected in the subdural hematoma of the patient during the burr hole surgery.…”

Scapular metastasis of hepatocellular carcinoma presenting as acute bleeding and hematoma

“…[ 4 – 13 ] Previously, cases of skull, rib, external auditory canal, maxilla, and mandible metastases from HCC with the development of bleeding and hematoma have been reported. [ 5 – 13 ]…”

“…The occurrence of bleeding and hematoma from bone metastasis of HCC is extremely rare. [ 5 – 14 ] Here, we present a case of scapular metastasis of HCC associated with acute bleeding and hematoma, and review the literature pertaining to this condition.…”

Management of patients suffering from hemorrhagic intracranial metastases: Propositions to help the neurosurgeon in emergency situations based on a literature review

“…In case of leukemia or hemopathy, the subdural hematoma can be independent of the bleeding diathesis induced by the disease. This invasion of the dura-mater should lead to perform a dural biopsy during the surgical procedure of the hematoma evacuation [22,25].…”