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

DOI: 10.1186/1752-1947-2-211

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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.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.Choriocarcinoma is a rare gestational trophoblastic disease that complicates approximately 1 in 50,000 term pregnancies and 1 in 30 hydatidiform moles[1]. Among confirmed cases of choriocarcinoma, 45% occur after molar pregnancy, 24% after normal term pregnancy, 25% after spontaneous abortion, and 5% after ectopic pregnancy[2]. Prognosis of this disease is generally good, 80–90% long-term survival with chemotherapy, radiotherapy, and surgical excision in appropriate cases[3]. One of the indicators of a poor prognosis is intracranial metastases, which complicate between 3 and 28% of gestational choriocarcinoma[1]. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma and present a review of the literature pertaining to subdural hematoma in this setting.The patient is a 34-year-old woman who had an acute episode of excruciating headache and was later found obtunded. She had a history of a normal pregnancy three years prior to presentation. She then had an abnormal pregnancy requiring dilation and evacuation at 10–12 weeks that was found to be a molar pregnancy. She became pregnant again 9 months after the dilation and evacuation of the molar pregnancy. This ended in a spontaneous, uncomplicated delivery 5 months prior to her presentation. There was no histor


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