Brain Metastasis Localized to the Same Area of Infarction: Illustrative Case

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2023 Aug 15

PMID 37581584

Authors

Oday Atallah

Bipin Chaurasia

Affiliations

Soon will be listed here.

Abstract

Background: Ischemic stroke and tumor account for a disproportionate share of deaths and disabilities among the elderly. Patients with a tumor who develop recurrent acute neurological deficits after a stroke can be at risk for tumor-related stroke. In contrast, brain metastases (BM) are common causes of neurological symptoms and are associated with a poor prognosis in patients with both malignancy and ischemic stroke.

Observations: The authors report a rare case of metastatic melanoma that manifested in the same region as a previous ischemic infarction. A 22-year-old female presented at our emergency department with right hemiparesis and sensory difficulties. Infarction in the left frontoparietal and basal ganglia regions was found on a computed tomography scan of the brain. A decompressive hemicraniectomy was performed urgently. After 16 years, a biopsy taken from her chin revealed malignant melanoma. Hemorrhagic metastasis on the frontal lobe of the brain was detected with magnetic resonance imaging and was histopathologically confirmed upon resection.

Lessons: In addition to recurrence, BM may be considered when a person with ischemic stroke and a cancer such as melanoma has new neurological problems in one area that cannot be explained by the stroke.

References

Nielsen S, Posner J . Brain metastasis localized to an area of infarction. J Neurooncol. 1983; 1(3):191-5. DOI: 10.1007/BF00165602. View

Pikula A, Beiser A, Chen T, Preis S, Vorgias D, DeCarli C . Serum brain-derived neurotrophic factor and vascular endothelial growth factor levels are associated with risk of stroke and vascular brain injury: Framingham Study. Stroke. 2013; 44(10):2768-75. PMC: 3873715. DOI: 10.1161/STROKEAHA.113.001447. View

Talwar T, Srivastava M . Role of vascular endothelial growth factor and other growth factors in post-stroke recovery. Ann Indian Acad Neurol. 2014; 17(1):1-6. PMC: 3992742. DOI: 10.4103/0972-2327.128519. View

Graus F, Rogers L, Posner J . Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985; 64(1):16-35. DOI: 10.1097/00005792-198501000-00002. View

Bang O, Chung J, Lee M, Seo W, Kim G, Ahn M . Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms. J Stroke. 2020; 22(1):1-10. PMC: 7005348. DOI: 10.5853/jos.2019.02278. View

Liu Q, Zhang H, Jiang X, Qian C, Liu Z, Luo D . Factors involved in cancer metastasis: a better understanding to "seed and soil" hypothesis. Mol Cancer. 2017; 16(1):176. PMC: 5712107. DOI: 10.1186/s12943-017-0742-4. View

Stelzer K . Epidemiology and prognosis of brain metastases. Surg Neurol Int. 2013; 4(Suppl 4):S192-202. PMC: 3656565. DOI: 10.4103/2152-7806.111296. View

Coit D, Thompson J, Albertini M, Barker C, Carson W, Contreras C . Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17(4):367-402. DOI: 10.6004/jnccn.2019.0018. View

Bleicher R, Essner R, Foshag L, Wanek L, Morton D . Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol. 2003; 21(7):1326-31. DOI: 10.1200/JCO.2003.06.123. View

10.

Gershenwald J, Scolyer R, Hess K, Sondak V, Long G, Ross M . Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67(6):472-492. PMC: 5978683. DOI: 10.3322/caac.21409. View

11.

Navi B, Iadecola C . Ischemic stroke in cancer patients: A review of an underappreciated pathology. Ann Neurol. 2018; 83(5):873-883. PMC: 6021225. DOI: 10.1002/ana.25227. View

12.

Zimm S, WAMPLER G, Stablein D, Hazra T, Young H . Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer. 1981; 48(2):384-94. DOI: 10.1002/1097-0142(19810715)48:2<384::aid-cncr2820480227>3.0.co;2-8. View

13.

Yamaguchi T, WALTZ A, Okazaki H . Hyperemia and ischemia in experimental cerebral infarction: correlation of histopathology and regional blood flow. Neurology. 1971; 21(6):565-78. DOI: 10.1212/wnl.21.6.565. View

14.

Mut M . Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg. 2011; 114(1):1-8. DOI: 10.1016/j.clineuro.2011.10.013. View

15.

Eroglu Z, Holmen S, Chen Q, Khushalani N, Amaravadi R, Thomas R . Melanoma central nervous system metastases: An update to approaches, challenges, and opportunities. Pigment Cell Melanoma Res. 2019; 32(3):458-469. PMC: 7771318. DOI: 10.1111/pcmr.12771. View

16.

Celia-Terrassa T, Kang Y . Metastatic niche functions and therapeutic opportunities. Nat Cell Biol. 2018; 20(8):868-877. DOI: 10.1038/s41556-018-0145-9. View

17.

Mozaffarian D, Benjamin E, Go A, Arnett D, Blaha M, Cushman M . Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2015; 133(4):e38-360. DOI: 10.1161/CIR.0000000000000350. View

18.

Colaco R, Martin P, Chiang V . Evolution of multidisciplinary brain metastasis management: case study and literature review. Yale J Biol Med. 2015; 88(2):157-65. PMC: 4445437. View

19.

Eisen T, Ahmad T, Flaherty K, Gore M, Kaye S, Marais R . Sorafenib in advanced melanoma: a Phase II randomised discontinuation trial analysis. Br J Cancer. 2006; 95(5):581-6. PMC: 2360687. DOI: 10.1038/sj.bjc.6603291. View

20.

Schouten L, Rutten J, Huveneers H, Twijnstra A . Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002; 94(10):2698-705. DOI: 10.1002/cncr.10541. View