J Korean Neurosurg Soc.  2010 Aug;48(2):166-169. 10.3340/jkns.2010.48.2.166.

Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma

• Kim BG
• Yoon SM
• Bae HG
• Yun IG

• KMID: 2138396
• DOI: http://doi.org/10.3340/jkns.2010.48.2.166

Abstract

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.

Keyword

Spontaneous epidural hematoma; Hepatocellular carcinoma; Dural metastasis

MeSH Terms

Anisocoria
Brain
Carcinoma, Hepatocellular
Cranial Fossa, Middle
Craniotomy
Decerebrate State
Floors and Floorcoverings
Hematoma, Epidural, Cranial
Hemorrhage
Humans
Male
Middle Aged
Neoplasm Metastasis
Neurosurgery