Clinical Features of Liver Cancer with Cerebral Hemorrhage

Abstract

BACKGROUND Cerebral hemorrhage is common in patients with cancer, but the clinical features and pathogenesis of liver cancer patients with cerebral hemorrhage are not well known. MATERIAL AND METHODS Liver cancer patients who developed cerebral hemorrhage were recruited from the First Affiliated Hospital of Guangxi Medical University between January 2003 and December 2014. We retrospectively analyzed clinical presentations, results of laboratory tests, and imaging examinations. The clinical features and pathogenesis were summarized. RESULTS Among 11133 patients with liver cancer, 9 patients (0.08%), including 3 females and 6 males met the inclusion criteria. The age range was 48-73 years and the average age was 61.67±8.97 years. Five patients did not have traditional hemorrhage risk factors and 4s had the risk factors; however, all had developed hepatocellular carcinoma, and 3 had developed metastasis. All 9 patients showed elevated tumor markers: an increased AFP level was detected in 6 patients, coagulation dysfunctions in 8 patients, and abnormal liver functions in 6 patients. Five patients had developed cerebral hemorrhagic lesions in the lobes of their brains, while hemorrhagic lesions in the basal ganglia occurred in 3 patients and in the brainstem in only 1 patient. Four patients had clear consciousness, while 5 patients were in coma and showed poor prognosis. CONCLUSIONS Patients who have liver cancer complicated with cerebral hemorrhage usually lack traditional risk factors of cerebral hemorrhage. The site of cerebral hemorrhage is often detected in the lobes of the brain. Coagulation dysfunctions might be the main pathogenesis of liver cancer complicated with cerebral hemorrhage.

Figure 1

CT images showing cerebral hemorrhage. (A1–A3) Patient #5 with traditional risk factors of cerebral hemorrhage; the patient was hospitalized as soon as cerebral hemorrhage was detected. Subsequently, liver cancer was detected in this patient at 1 day after admission. CT images showed that a cerebral hemorrhage had developed at the left basal ganglion. (B1–B3) Patient #7 did not have any traditional risk factors of cerebral hemorrhage; however, 12 months after the diagnosis of liver cancer, the patient developed cerebral hemorrhage. A CT scan showed that a cerebral hemorrhage had developed in the left parietal lobe. (C1–C3) Patient #8 also did not have any traditional risk factors for cerebral hemorrhage. The patient was hospitalized due to cerebral hemorrhage and was diagnosed with liver cancer 6 days after admission. A CT scan showed that a cerebral hemorrhage occurred at the left occipital lobe.