Small cell lung carcinoma causing epidural hematoma: Case report

BACKGROUND Epidural hematoma usually stems from trauma, yet it may occur fr om other etiologies, including neoplasms. We present a case of small cell l ung carcinoma with focal hemorrhagic central nervous system metastasis prod ucing an epidural hematoma, and review the associated literature. CLINICAL PRESENTATION A 67-year-old man was undergoing chemotherapy for sma ll cell carcinoma of the lung, Acute neurologic deterioration resulted from a large parietal epidural hematoma of non-traumatic origin. INTERVENTION The clot was evacuated via craniotomy with marked improvement in his clinical state. Metastatic tumor was present in the scalp, muscle, b one, and dura. No gross brain invasion was apparent. CONCLUSIONS This case illustrates the wisdom of including metastatic diseas e in the differential diagnosis of intracranial hemorrhage. Even epidural h ematoma may result from metastatic cancer. The prevalence of lung carcinoma and the aging of the population may produce an increased appearance of thi s phenomenon. Appropriate evaluation and rapid intervention will aid the pa tient in both the acute and long-term phases, and should improve the qualit y of survival. (C) 1999 by Elsevier Science Inc.