Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report

Brandon G Rocque and Mustafa K Başkaya

Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA

author email corresponding author email

Journal of Medical Case Reports 2008, 2:211doi:10.1186/1752-1947-2-211


Published:	19 June 2008

Abstract

Introduction

Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotid-cavernous fistula. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma.

Case presentation

The patient is a 34-year-old woman whose initial presentation of widely metastatic choriocarcinoma was an acute subdural hematoma, requiring decompressive craniectomy. Histopathologic examination of the tissue showed no evidence of choriocarcinoma, but the patient was found to have diffuse metastatic disease and cerebrospinal fluid indices highly suggestive of intracranial metastasis.

Conclusion

Choriocarcinoma frequently metastasizes intracranially. We review the diverse possible manifestations of this process. In addition, the cerebrospinal fluid:serum beta-human chorionic gonadotropin ratio is an important factor in diagnosing these cases. Finally, the role of the neurosurgeon is discussed.