Spontaneous intracranial epidural hematoma originating from dural metastasis of hepatocellular carcinoma

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.

Keywords: Dural metastasis; Hepatocellular carcinoma; Spontaneous epidural hematoma.

Fig. 1

Brain CT scans showing a huge epidural hematoma from the right temporal base to the cerebral convexity with severe mass effect.

Fig. 2

Brain CT scans showing osteolytic bone lesion on the middle cranial fossa floor. Axial (A) and sagittal (B) views of bone window level show eroded right temporal base (open arrows). Bony defect (black arrow) is well visualized on CT window image (C).

Fig. 3

Photomicrographs obtained from the thickened dura matter showing metastatic hepatocellular carcinoma. A : Sinusoidal pattern of anaplastic cells is demonstrated in dural layer (H & E, ×100). B : Sinusoidal blood vessels (H & E, ×400). C : Hepatocyte antibody immunostain showing metastatic poorly differentiated hepatocyte with mitosis.