Abstract
Background Intracerebral hemorrhage (ICH) in younger females is usually attributed to ruptured aneurysms or cerebrovascular malformations. By contrast, metastatic brain tumors and complications stemming from intracranial venous sinus thrombosis (CVST)-associated hemorrhagic strokes are rare instigators of ICH in women of childbearing age. We report a case of choriocarcinoma metastasis with rapid progression of cerebral venous sinus thrombosis in a patient in the third trimester. Additionally, the literature review revealed only two cases where choriocarcinoma was complicated by CVST, and both were identified post-chemotherapy.
Case presentation A case of a 33-year-old expectant woman, in her 32+ weeks of pregnancy, sought hospital admission owing to persistent blurred vision that had prevailed for over half a month. After her admission, she endured three instances of ICH within only one week, during which period digital subtraction angiography unveiled the presence of thrombosis within the superior sagittal sinus. Choriocarcinoma in the third trimester with lung and brain metastases, ICH, and CVST. The patient underwent an emergency caesarean section and delivered a premature baby girl. Catheter directed thrombolysis in the intracranial venous sinus and evacuation of the hematoma by craniotomy were subsequently performed. Eventually, this patient was diagnosed with choriocarcinoma with multiple metastases and received drug chemotherapy.
Conclusions The symptoms and imaging findings of brain metastases with hemorrhage and CVST overlap with each other, resulting in delaying and confusing the diagnosis. Furthermore, early diagnostic interventions for choriocarcinoma coupled with intensive treatment strategies can potentially improve patient prognosis and help avoid life-threatening consequences.