Small cell lung carcinoma causing epidural hematoma: Case report

BACKGROUND Epidural hematoma usually stems from trauma, yet it may occur from other etiologies, including neoplasms. We present a case of small cell lung carcinoma with focal hemorrhagic central nervous system metastasis producing an epidural hematoma, and review the associated literature. CLINICAL PRESENTATION A 67-year-old man was undergoing chemotherapy for small 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, bone, and dura. No gross brain invasion was apparent. CONCLUSIONS This case illustrates the wisdom of including metastatic disease in the differential diagnosis of intracranial hemorrhage. Even epidural hematoma may result from metastatic cancer. The prevalence of lung carcinoma and the aging of the population may produce an increased appearance of this phenomenon. Appropriate evaluation and rapid intervention will aid the patient in both the acute and long-term phases, and should improve the quality of survival. (C) 1999 by Elsevier Science Inc.