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• W2788649903 abstract "We have read with great interest the study published in The American Journal of Medicine by Juan et al.1Juan Y.H. Hsuan H.F. Cheung Y.C. et al.Pointing to the diagnosis: hemorrhagic brain metastasis.Am J Med. 2016; 129: 1268-1269Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The authors presented a patient with symptoms of left hemiparesis and left facial palsy for whom computed tomography of the brain showed a single hemorrhagic lesion in the right basal ganglia. They also reported that the patient had a medical history of adenocarcinoma of the lung and hypertension. They presented a diagnostic dilemma, with hemorrhagic stroke or hemorrhagic brain metastasis as the cause of the hemorrhagic lesion. Biopsy of the brain lesion confirmed the diagnosis of hemorrhagic brain metastasis from adenocarcinoma of the lung. Biopsy is considered necessary for the determination of brain lesions, even for hemorrhagic lesions that represent a form of intracranial hemorrhage. However, there are cases in which the results of the biopsy do not provide a definite diagnosis of the type of the lesion, or in which a biopsy is considered impossible owing to the poor health status of the patient. In such cases the differential diagnosis may be challenging for the doctors who have to define the most probable diagnosis. The frequency of hemorrhage in patients with intracranial neoplasm ranges from 1.3% to 14.6%.2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar Furthermore, it has been estimated that intracranial hemorrhage in patients with cancer is related to 31% of 30-day mortality and 78% of 1-year mortality.2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar A study of 141 cancer patients with a medical history of solid tumor (excluding primary brain and liquid tumors) who presented with intracranial hemorrhage showed that the most commonly reported reasons for intracranial hemorrhage were intratumoral hemorrhage (70%), coagulation disorders (39%), or a combination of both (23%).2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar The same study showed that hypertension (6%), trauma (4%), and hemorrhagic conversion after an ischemic event (3%), aneurysmal rupture (2%), and venous thrombosis (1%) were other rare causes of intracranial hemorrhage.2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar It is notable that the most commonly reported reasons for intracranial hemorrhage in patients with cancer are different compared with the general population.2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar Coagulopathy or other hematologic disorders should be excluded in patients with malignancy if intracranial hemorrhage is documented. Nevertheless, a coagulopathy disorder has been reported that should be considered if any of the below are presented: platelets <100/mm3, international normalized ratio >1.5, partial thromboplastin time >45 seconds, disseminated intravascular coagulation, or if a previous full-dose low-molecular-weight heparin was administered within the past 48 hours.2Navi B.B. Reichman J.S. Berlin D. et al.Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501Crossref PubMed Scopus (80) Google Scholar Intratumoral hemorrhage should be considered as the most probable cause of intracranial hemorrhage in cancer patients with a known solid tumor, particularly if a concurrent coagulopathy has been excluded." @default.
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• W2788649903 date "2018-03-01" @default.
• W2788649903 modified "2023-09-24" @default.
• W2788649903 title "Hemorrhagic Brain Metastases as a Diagnosis of Exclusion: A Diagnostic Dilemma" @default.
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• W2788649903 doi "https://doi.org/10.1016/j.amjmed.2017.11.008" @default.
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