Intracerebral hemorrhage from a metastatic brain tumor. Importance of differential diagnosis preceding stereotaxic hematoma aspiration

Niizuma, H; Nakasato, Nobukazu; Yonemitsu, Tsutomu; Ito, Seikou; Suzuki, Jirô

doi:10.1016/0090-3019(88)90012-2

Cited by 12 publications

(7 citation statements)

References 9 publications

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“…Indeed, lobar ICH is the result of other heterogeneous causes, including arteriovenous malformation, cavernous angioma, aneurysm, brain tumors, especially those of metastatic origin (2,3), the use of anticoagulant or fibrinolytic agents, cerebral amyloid angiopathy and vasculitis (2). Furthermore, the frequency of lobar ICH complicated by amphetamines (4), pseudoephedrine (5), and cocaine (6) has increased recently.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

et al. 2003

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ObjectivesThe underlying cause of lobar intracerebral hemorrhage (ICH) is often difficult to determine, since these vascular abnormalities are not necessarily visualized in radiographic studies. Wesought to determine the clinical features of hypertensive and nonhypertensive lobar ICH, and further predict the presence or absence of vascular abnormalities in terms of clinical features and radiographic abnormalities.Patients and Methods Eighty-one patients with lobar ICH were retrospectively assigned to either hypertensive or non-hypertensive groups based on their blood pressure levels during the chronic phase or a history of antihypertensive medication. The clinical and radiographic features of these two groups were compared.Results Forty-nine patients (60%) were hypertensive, and the other thirty-two (40%) were non-hypertensive.In the non-hypertensive group, amyloid angiopathy (n= 6), aneurysms (n=5), arteriovenous malformation (n=4), use of anticoagulants (n=2), liver cirrhosis (n=2) and thrombasthenia (n=l) were found as underlying causes.There were no significant differences between these two groups in the frequencies of stroke risk factors except for hypertension, clinical features and initial neurological findings. On the contrary, subarachnoid extension of the hematomaon CT was significantly more frequent in the non-hypertensive lobar ICH group than in the hypertensive group (p<0.001). The patients with subarachnoid extension were morelikely to have vascular abnormality than those without subarachnoid extension (p<0.01). Conclusion Subarachnoid extension of the hematoma on CTstrongly indicates a non-hypertensive cause, and more specifically, it suggests lobar ICH caused by vascular abnormalities.

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Section: Introductionmentioning

confidence: 99%

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

et al. 2003

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“…7 CT scan findings of a hemorrhagic metastasis include a neoplastic core (high or low density), small, multifocal clots usually at the margin of the tumor, and surrounding, often extensive, edema. [10][11][12] However, metastatic RCC mimicking a ruptured DACA aneurysm on CT scan has not been reported. 9 In fact RCC metastasis to the brain can have varied presentations and can mimic both venous infarct and primary subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Renal Cell Carcinoma Metastasis Mimicking a Ruptured Distal Anterior Cerebral Artery Aneurysm

Nayil¹,

Gazanfar²,

Chugh

et al. 2010

Neurosurgery Quarterly

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Renal cell carcinoma is known to produce hemorrhagic metastasis in the brain. In this study a 45-year-old female is discussed in whom we suspected a ruptured distal anterior cerebral artery aneurysm. Cerebral angiogram was normal. The patient was operated in the past for renal cell carcinoma. A magnetic resonance imaging of the brain showed hemorrhagic mass involving the corpus callosum and infiltrating both the frontal lobes. She was subjected to radiosurgery. We conclude that in case of a primary cancer known to produce a hemorrhagic lesion in the brain, metastasis should always be excluded even if the presentation is of acute stroke.

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“…10,11,13,14,18) Hypertension and coagulopathy are thought to be risk factors of intratumoral hemorrhage in some cases, but the etiologies of intratumoral hemorrhage are often considered to be endothelial proliferation with vascular obliteration, vessel compression, and/or distortion due to rapid tumor growth, vessel necrosis, invasion of vessel walls by the tumor, and/or increased venous pressure associated with increased intracranial pressure. [9][10][11][12][13][14][15]19) The histological features of tumors that bleed microscopically or macroscopically include tumor necrosis as well as the vascular changes of vessel-wall hyalinization, degeneration or necrosis of vessel walls, thrombosis, and the presence of many thin-walled fragile vessels and ruptured vessels. Hemorrhage from tumors is also believed to be influenced by treatment, disturbance of venous drainage, or rapid tumor necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…10,18) Among metastatic brain tumors, choriocarcinoma, malignant melanoma, bronchogenic carcinoma, and renal cell carcinoma frequently develop significant hemorrhage. 10,11,13,14,18) Both primary and metastatic choriocarcinomas very frequently show hemorrhage. Such hemorrhage is considered to be due to the inherent propensity of trophoblasts to specifically invade and destroy vessel walls.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Bronchogenic Carcinoma with Human Chorionic Gonadotropin Production Manifesting as Cerebellar Hemorrhage. Case Report.

Sawa

Taomoto

Tamaki

et al. 2001

Neurol. Med. Chir.(Tokyo)

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A 58-year-old male presented with a rare case of brain metastatic bronchogenic carcinoma with human chorionic gonadotropin (hCG) production causing cerebellar hemorrhage with symptoms of nausea, vomiting, and headache. Bronchogenic carcinoma manifesting as gynecomastia had been resected a few months previously. Neurological examination revealed left cerebellar ataxia. Neuroimaging showed multiple cerebellar metastases with cerebellar hemorrhage adjacent to the tentorium. Angiography demonstrated tumor staining fed by the hemispheric branch of the left posterior inferior cerebellar artery. Suboccipital craniectomy was performed. The left cerebellar hematoma was evacuated and the tumor was partially removed to prevent massive intraoperative hemorrhage and avoid brain stem injury. Histological examination showed the resected tumor was large cell carcinoma. hCG was detected in the cerebrospinal fluid and was identified by immunohistochemical staining in tumor cells. The primary lesion of bronchogenic carcinoma showed choriocarcinomatous change because the tumor could produce hCG. The choriocarcinomatous cells with higher metastatic potential formed lesions in the brain, and finally intratumoral hemorrhage occurred producing the rapid development of symptoms.

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Intracerebral hemorrhage from a metastatic brain tumor. Importance of differential diagnosis preceding stereotaxic hematoma aspiration

Cited by 12 publications

References 9 publications

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

Clinical and Radiographic Features of Lobar Cerebral Hemorrhage: Hypertensive Versus Non-hypertensive Cases

Renal Cell Carcinoma Metastasis Mimicking a Ruptured Distal Anterior Cerebral Artery Aneurysm

Metastatic Bronchogenic Carcinoma with Human Chorionic Gonadotropin Production Manifesting as Cerebellar Hemorrhage. Case Report.

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