Abstract
Six patients with unsuspected brain tumors presented symptoms of intracerebral hemorrhage. The initial symptoms were a sudden onset of headache and vomiting, sometimes followed by disturbance of consciousness and focal symptoms. The patients had no history of hypertension, evidence of bleeding disorders, or prior anticoagulant therapy. The medical history was important in patients with primary malignancy outside the central nervous system. Massive cerebral hemorrhage from metastatic chorioepithelioma was suspected in women of childbearing age with a recent history of pregnancy, abnormal vaginal bleeding, and/or amenorrhea. The intracranial lesions were demonstrated by computerized tomography (CT) scans. The characteristic CT findings included round and heterogeneous or lobulated, high-density areas of coagulation, perifocal low-density areas, and lesions of contrast enhancement. Three cases were operated on immediately. Two cases were operated 9 and 16 months after hemorrhage, when signs of brain tumor appeared. Histological examination revealed 1 undifferentiated sarcoma of the leptomeninges, 1 anaplastic astrocytoma, and 3 metastatic tumors (including 1 melanoma and 2 chorioepitheliomas). One was an unverified thalamic tumor.
