Intracranial Hemorrhage Caused by Metastatic Tumors

Abstract

The incidence of the brain tumor observed in the aged was 116 cases (7.7%) among 1500 autopsies in the Tokyo Metropolitan Geriatric Hospital and metastatic one was composed of 62.1% of tumor cases. The hemorrhagic brain tumor consists of primary tumor in 34.1% and metastatic one in 22.2%. In the latter lung cancer was most frequent (62.5%), followed by 12.5% of gastric cancer. Considering that the lung cancer was the most frequent metastatic tumor (61.1%), the corrected incidence of the hemorrhagic metastasis was 22.7% of lung cancer and 33.3% of gastric cancer. The localization of the metastasis was in the cerebral cortex (80%), deep cerebrum (40%), cerebellum (33%) and brain stem (13%). Some were complicated by ventricular rupture and carcinomatous meningitis. The size of the bleeding was various and the cases with the hematoma measuring over 5cm in diameter showed consciousness disturbance. Multiple hemorrhages were observed in 12 cases among 15 hemorrhagic metastatic cases. The clinical symptomes of the hemorrhagic metastatic tumor was shown in 15 cases and convulsion was the most frequent one, then demintia, vertigo, hemiplegia, coma, etc. In the cases, in which such symptoms appeared before the detection of the tumor, the differential diganosis from cerebrovascular disease was often difficult. Such cases were 5 and other 11 cases showed neurological symptoms after detection of tumor. The former consisted of 4 cases of lung cancer and a case of gastric cancer. Their neurological symptoms were hemiplegia, convulsion, deafness, frontal sign, consciousness disturbance, gait disturbance, ataxia, tremor, vertigo, dysarthria, etc. However, the massive bleeding was not observed in these cases but in the cases in which the tumor had been already found. Complication of DIC was observed in 30% of hemorrhagic cases and that of hypertension in 50%. The incidence was not different from that of non-bleeding cases.
The mechanism of bleeding of the metastatic brain tumor has been considered variously, e. g. rupture of neoplastic aneurysm, bleeding from intraneoplastic or perineoplastic proliferated capillaries, bleeding due to congestion of vein by compression, hemorrhagic infarction due to tumor embolism, or fibrinolysis in the peritumoral brain parenchym. Histological examination of bleeding focus of lung cancer metastasis by serial section did not reveal neoplastic aneurysm, but disrrupted capillaries due to tumor infiltration.