Sudden Onset Multifocal Brain Metastasis of Liver Cancer

A case of brain metastasis of liver cancer is reported. A 47-year-old male was admitted with the episode of sudden onset left hemiparesis and conjugate deviation toward the right. Computerized tomography at admission showed three high density areas with perifocal edema, in the right temporal, parietal and posterior lobes. The right carotid angiogram showed abnormal feeding vessels from the middle cerebral artery and tumor stain in the right temporal lobe. His conscious level deteriorated quickly, therefore a large right craniotomy and evacuation of the hematomas were performed. However, he did not recover and died 4 days later. Post-mortem examination revealed a primary liver cancer (hepatocellular carcinoma) and metastatic foci in the brain, dura mater, skull, adrenal glands and lungs. The tumor cells were found in the clot which had been evacuated at the operation and in the parenchyma around the hematoma cavities at the post-mortem examination. Therefore, it was concluded that two large hematomas in the parietal and occipital lobes were caused by the metastatic nodules and the temporal lesion was the tumor itself.