Subdural hemorrhage from a hepatoma due to metastasis

Dural metastasis with subdural hemorrhage is very rare. We report a 69-year-old woman who visited our emergency department with a history of nausea and vomiting for 6 days. Computed tomography of the brain with enhancement showed a space-occupying lesion over temporal skull with subdural hematoma. Abdominal sonography revealed a liver tumor. Emergent craniotomy and resection of intracranial tumor were performed because of impaired consciousness on the 4th day after admission. A pathological analysis of the cranial lesion later confirmed the diagnosis of metastatic hepatocellular carcinoma with skull involvement. After a complete survey of her hepatoma, she received tumor embolization and was discharged. However, 6 months later, she died because of multiple brain metastases, leading to subdural hemorrhage and intracranial hemorrhage. Although intracranial metastatic lesions are rare, they are life-threatening because of the lack of obvious history that usually leads to delayed diagnosis. A literature review was performed to shed light on the frequency and importance of this rare but important clinical entity.