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  • Title: Recurrent metastatic hepatocellular carcinoma presenting as consecutive "mirror image" intracerebral haematomas.
    Author: Cho DC, Yi HJ, Ko Y, Oh SJ, Lee SR, Paik SS.
    Journal: J Clin Neurosci; 2005 Aug; 12(6):699-702. PubMed ID: 16115554.
    Abstract:
    A 34-year old man with a past history of hepatocellular carcinoma (HCC) complained of headache and visual disturbance. Neuroimaging revealed a right occipital haematoma with rim enhancement and at operation, a metastasis from the primary malignancy was found. Five months after surgery and subsequent adjuvant therapy, he presented with blindness. On neuroimaging, a left occipital haematoma was seen. The patient refused surgical intervention. HCC usually has an aggressive clinical course; therefore, recurrent cerebral metastasis is an uncommon clinical problem. "Mirror-image" metastasis, with bleeding in both hemispheres, is rare and has not been reported. We suggest that these metastases occur due to microscopic seeding via an arterial route, and that spread via a venous route, such as occurs through Batson's plexus, is unlikely.
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