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Abstract Details

Metastatic Choriocarcinoma Presents Challenge in Addressing Intracranial Pressure
Neuro Trauma and Critical Care
P9 - Poster Session 9 (11:45 AM-12:45 PM)
7-010

The objective is to present a case of postpartum choriocarcinoma with multifocal bilateral hemorrhagic brain metastases, where the time from diagnosis to death was six days. The case posed significant challenges in managing intracranial pressure (ICP) despite the use of multimodal therapy.

Choriocarcinoma is a subtype of gestational trophoblastic neoplasia, with a prevalence of around one in 50,000 pregnancies. It commonly metastasizes to the lungs, liver, and pelvic cavity, but in rare cases, it can metastasize to the brain. The response to chemotherapy is well-documented; however, our case this was influenced by poor prognostic factors such as antecedent term pregnancy and location of metastasis. Our case presents a challenging diagnosis and explores management considerations for ICP in the setting of multifocal hemorrhage. 
Case report
A 34-year-old woman with a history of lupus presented on postpartum day 4 with severe headache, right-sided weakness, and a one-month history of blurry vision. Upon admission, Stage IV metastatic choriocarcinoma was diagnosed. Neuroimaging revealed nine hemorrhagic metastatic brain lesions with necrotic cores and intraventricular hemorrhage. Metastases were also present in the liver and lungs. Progressive hemorrhagic expansion of intracranial lesions occurred on days three, five, and six, accompanied by seizures on days four and six, leading to decreased consciousness and necessitating intubation. Despite aggressive interventions, including corticosteroids, chemotherapy, and whole-brain radiation, the patient succumbed to tonsillar herniation on day six, culminating in the patient's death. 

This case highlights the clinical challenges of metastatic choriocarcinoma involving the CNS and emphasizes the need for early ICP monitoring and management. While chemotherapy is the standard of care for choriocarcinoma, neurosurgical and radiosurgery intervention could offer potential benefits in selected cases to optimize outcomes and reduce mortality risks.

Authors/Disclosures
Keti Gvazava, MD
PRESENTER 		Dr. Gvazava has nothing to disclose.
Nihal Satyadev, MD, MPH (Mayo Clinic) Dr. Satyadev has nothing to disclose.
Jeffrey B. Peel, MD (Mayo Clinic) Dr. Peel has nothing to disclose.
Christopher L. Kramer, MD (Mayo Clinic) Dr. Kramer has nothing to disclose.
Lauren Ng, MD Dr. Ng has nothing to disclose.
Gabriel Bendfeldt, MD Dr. Bendfeldt has nothing to disclose.
MUTAZ S. OMBADA, MD Dr. OMBADA has nothing to disclose.
Johnny Cebak, DO, PhD (Mayo) Dr. Cebak has nothing to disclose.
Danelia Martinez, NP Mrs. Martinez has nothing to disclose.
Nikki Matos, NP Mrs. Matos has nothing to disclose.
Ansley Madala, MD (Mayo Clinic Florida - Neurology) Dr. Madala has nothing to disclose.
William D. Freeman, MD, FAAN (Mayo Clinic) Dr. Freeman has nothing to disclose.