Unexpected Intraparenchymal Hematoma Caused by Brain Metastasis in a Patient With Neuroblastoma : Case Report
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概要
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A 2-year-old girl who had previously been treated for stage IV intra-abdominal neuroblastoma presented with headache and vomiting. Computed tomography (CT) showed hematoma in the right temporal lobe. Two months previously, she had suffered a generalized seizure but brain CT was unremarkable. The hematoma was removed completely without evidence of vascular anomaly or tumor. Four weeks after surgery, magnetic resonance imaging with gadolinium showed a developing mass lesion in the hematoma bed. A second operation for tumor removal confirmed the rare diagnosis of intraparenchymal metastasis. Metastatic neuroblastoma to the central nervous system (CNS) occasionally can cause massive hemorrhage. Therefore, early detection of CNS metastasis can be important. The related factors in this patient with abdominal neuroblastoma included elevated serum lactate dehydrogenase, N-myc gene amplification, and coexisting orbital metastasis, which all occurred within 22 months from initial diagnosis. The median interval from diagnosis of the primary tumor to diagnosis of CNS metastasis in neuroblastoma is 12-22 months, which indicates relatively late metastasis presentation. The initial presentation of this late metastasis is hemorrhage that can have sudden detrimental consequences, so a patient with neuroblastoma must be followed up carefully, particularly if elevated serum lactate dehydrogenase, orbital metastasis, N-myc gene amplification, or clinical symptoms are present, even if brain CT is unremarkable. The understanding that intraparenchymal hematoma can occur prior to detectable CNS metastasis may be important for early detection of this life-threatening condition.
- 2011-11-15
著者
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Saito Youhei
Department Of Biochemistry And Molecular Biology Kyoto Pharmaceutical University
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Kasuga Chinatsu
Department Of Neurosurgery Juntendo University School Of Medicine
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Arai Hajime
Department Of Hematology And Oncology University Of Fukui
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Okura Hidehiro
Department Of Neurosurgery Juntendo Urayasu Hospital
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Miyajima Masakazu
Department Of Neurosurgery Juntendo University
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Karagiozov Kostadin
Department Of Neurosurgery Sabah Hospital
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Ishii Hisato
Department Of Neurosurgery Juntendo University Izunagaoka Hospital
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Ishii Hisato
Department Of Neurosurgery Juntendo University School Of Medicine
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YATOMI Kenji
Department of Neurosurgery, Juntendo University School of Medicine
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Yatomi Kenji
Department Of Neurosurgery Juntendo University School Of Medicine
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Karagiozov Kostadin
Department Of Neurosurgery Juntendo University School Of Medicine
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Okura Hidehiro
Department Of Neurosurgery Juntendo University School Of Medicine
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Saito Youhei
Department Of Pediatrics Juntendo University School Of Medicine
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