Recurrent cerebral hemorrhage with brain metastasis of choriocarcinoma presenting as initially absent and later identified as oncotic aneurysms: A case report and literature review

Background: Neoplastic cerebral aneurysms with intracerebral hemorrhage (ICH) occur very rarely in young patients, and these cases are often observed relative to metastatic choriocarcinoma. We report a case of a childbearing female patient with recurrent ICHs, who was presumed to be metastatic choriocarcinoma and present a review of the literature. Case description: A 35-year-old woman visited the emergency room with ICHs in the left basal ganglia, parietal lobe, and the intraventricle. However, no vascular abnormalities were found in the initial magnetic resonance (MR) angiography. On the fifteenth day of hospitalization after conservative care, she had recurrent ICHs at other sites with a decrease in consciousness and underwent emergency surgery. A subsequent angiographic study showed several aneurysms and enhanced brain MR images and MR spectroscopy showed leptomeningeal and parenchymal carcinomatosis at both parietal areas. In addition, the chest CT showed a lung mass, and high levels of serum and cerebrospinal fluid (CSF) beta-human chorionic gonadotropin (beta-hCG) were found. Based on these findings, the diagnosis of metastatic choriocarcinoma was made. Conclusion: A review of 30 cases of cerebral metastatic choriocarcinomas in the literature revealed that the prognosis is generally poor, but chemotherapy could achieve a better prognosis, and when pathologic results are difficult to obtain, serum and CSF beta-hCG may help make the diagnosis. It is worth performing another cerebral angiogram several days or weeks later in reproductive-age patients with ICH at unusual sites or recurrent ICHs, even if there are no vascular abnormalities in the initial angiographic studies.