Intracerebral hemorrhage cause by a ruptured oncotic aneurysm from choriocarcinoma metastasis
A 25-year-old woman presented with sudden onset of loss of consciousness for two hours. No history of hypertension or bleeding disorders could be identified. Non enhanced head computed tomography (CT) was performed revealing a large subcortical hematoma in the left parietal area []. The CT angiography (CTA) revealed a small aneurysm in the periphery of the middle cerebral artery (MCA) [Figures –]. The Glasgow Coma Score before surgery was seven. An emergency craniotomy was performed to remove the hematoma. A pseudo aneurysm of 0.8 cm. in diameter with perforation was identified at the left parietal lobe. The aneurysm was excised smoothly and a craniectomy was done secondary to brain swelling. The patient regained consciousness postoperatively with no neurologic deficit. Immunohistochemical staining of the aneurysm revealed a positive cytokeratin and beta – hCG [Figures –]. A chest X-ray showed multiple lung masses giving the impression of lung metastasis. Based on these studies, the diagnosis of metastatic choriocarcinoma was made. Serum beta – hCG was 73,656 ng/ml. After diagnosis, the patient received chemotherapy with EMA-CO regimen. Her beta – hCG decreased from 73,656 ng/ml to 3.8 ng/ml after three courses of chemotherapy.