Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8728-8734
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8728
Spontaneous acute epidural hematoma secondary to skull and dural metastasis of hepatocellular carcinoma: A case report
Guang-Zhao Lv, Guo-Chao Li, Wei-Tai Tang, Dong Zhou, Yong Yang
Guang-Zhao Lv, Dong Zhou, Yong Yang, Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Guo-Chao Li, Wei-Tai Tang, Department of Neurosurgery, Luoding People’s Hospital, Yunfu 527200, Guangdong Province, China
Author contributions: Lv GZ, Li GC and Yang Y were the patient’s neurosurgeons, reviewed the literature and contributed to manuscript drafting; Lv GZ reviewed the literature and contributed to manuscript drafting; Tang WT analyzed and interpreted the imaging findings; Zhou D was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by Natural Science Foundation of China, No. 81901250; Natural Science Foundation of Guangdong Province, No. 2019A1515010104 and No. 2022A1515012540; High-level Hospital Construction Project of Guangdong Provincial People’s Hospital, No. DFJH201924; and Science and Technology Program of Guangzhou, No. 202002030128.
Informed consent statement: The patient's legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: We have confirmed all the items on the CARE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Yang, MD, PhD, Neurosurgeon, Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan Er Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. yangyong@gdph.org.cn
Received: March 17, 2022
Peer-review started: March 17, 2022
First decision: May 30, 2022
Revised: June 12, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 26, 2022
Processing time: 151 Days and 9.7 Hours
Abstract
BACKGROUND

The skull and dura are uncommon sites for the metastasis of hepatocellular carcinoma (HCC). Spontaneous acute epidural hematoma (AEDH) is also very rare. We report here a spontaneous AEDH secondary to skull and dural metastasis of HCC. This case is extremely rare.

CASE SUMMARY

A 48-year-old male patient with a history of HCC developed unconsciousness spontaneously. Head computed tomography showed "a huge AEDH in the left parietal and occipital region with osteolytic destruction of the left parietal bone. Emergent operation was performed to evacuate the hematoma and resect the lesion. Pathological study revealed that the lesion was the metastases from HCC. The patient died of lung infection, anemia, and liver failure 3 wk after operation.

CONCLUSION

Spontaneous AEDH caused by hepatocellular carcinoma (HCC) dural and skull metastases is extremely rare, the outcome is poor. So, early diagnosis is important. If the level of AFP does not decrease with the shrinkage of intrahepatic lesions after treatment, it is necessary to be alert to the existence of extrahepatic metastases. Since most of the patients had scalp and bone masses, physicians should pay attention to the patient's head palpation. Once a patient with the history of HCC had sudden neurological dysfunction, the possibility of spontaneous AEDH caused by the skull and dura mater metastases should be considered. Since hemorrhage is common in the skull HCC metastases, for patients with spontaneous AEDH accompanied by skull osteolytic lesions, it is also necessary to be alert to the possibility of HCC. For AEDH secondary to HCC metastases, early diagnosis and timely treatment are critical to improve the patients’ outcomes.

Keywords: Spontaneous acute epidural hematoma; Hepatocellular carcinoma; Skull and dural metastasis; Case report

Core Tip: We present a case of hepatocellular carcinoma (HCC) metastasis to the skull and dura mater with spontaneous acute epidural hematoma (AEDH). This is the first report of spontaneous AEDH secondary to skull and dura mater metastasis from HCC in the Chinese population. Pathological examination provided evidence that the dura mater was one of the targets for HCC metastasis and could also lead to AEDH in addition to the reported skull metastases. We summarize the characteristics of the 8 reported cases worldwide, discuss the possible cause of AEDH, and offer advice for clinical practice.