ArticleJournal of medical case reports2026
Metastatic gestational trophoblastic neoplasia presenting initially as intraparenchymal and subdural hematoma: a case report.
Article in Journal of medical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGestational trophoblastic neoplasia is a rare but highly chemosensitive pregnancy-related malignancy with a strong tendency for hematogenous spread and hemorrhagic metastasis. Brain involvement occurs in a minority of patients and may present as life-threatening intracranial hemorrhage. CASE PRESENTATION: A 40-year-old Ethiopian woman presented with a sudden-onset severe headache, focal seizures, vomiting, and progressive right-sided weakness. She had a history of spontaneous abortion five months prior. Neuroimaging revealed a left frontoparietal intraparenchymal hemorrhagic mass with surrounding edema and a concomitant holohemispheric subacute subdural hematoma causing mass effect. Serum β-human chorionic gonadotropin (β-hCG) levels were elevated to 1500 IU/L. Although lower than the levels typically observed in disseminated choriocarcinoma, modest β-hCG elevations may occur in partially regressed primary lesions or in isolated metastatic disease. The patient underwent urgent craniotomy with evacuation of the subdural hematoma and resection of a hemorrhagic intraparenchymal metastatic lesion. Histopathological examination confirmed a diagnosis of metastatic choriocarcinoma. Staging evaluation revealed pulmonary and uterine involvement, consistent with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease, with a World Health Organization prognostic score of 11. She received multi-agent chemotherapy with progressive neurological recovery and normalization of β-hCG levels during follow-up.
conclusionSimultaneous intraparenchymal and subdural hemorrhages can represent a rare initial presentation of metastatic gestational trophoblastic neoplasia, even in the absence of gynecologic symptoms. Prompt measurement of serum β-hCG levels is essential for early diagnosis of unexplained intracranial hemorrhage in women of reproductive age. Early neurosurgical intervention combined with timely multi-agent chemotherapy can result in favorable outcomes, even in high-risk stage IV disease with brain metastasis.
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