■在表现为脑出血非典型特征的年轻女性中,应将转移性绒毛膜癌视为鉴别诊断。在资源贫乏的环境中,高怀疑指数和血清β-hCG对诊断至关重要。
■年轻人的脑出血很少由转移性绒毛膜癌引起。这种情况的诊断在资源匮乏的环境中可能特别具有挑战性,其中对诊断技术的访问可能受到限制。我们介绍了一系列病例,其中三名年轻女性在最初出现脑出血后被诊断为转移性绒毛膜癌,每个都表现出独特的临床表现。我们的目标是强调在处理这种罕见的脑出血原因时的诊断考虑因素。尤其是在资源受限的环境中。病例1涉及一名21岁的女性,最初被诊断为脑出血,可能来自未知的主要来源。进一步评估显示β-hCG水平极高,并提示宫内恶性肿瘤。这导致了转移性绒毛膜癌的诊断。这进一步因肺栓塞而变得复杂。不幸的是,她在治疗期间死于呼吸衰竭。病例2是一名年轻女性,她被送往急诊室,并作为脑叶内出血的病例进行了治疗。进一步的检查显示,以前的子宫切除术史是因为胎盘部位滋养细胞肿瘤,这促进了绒毛膜癌的评估。病例3涉及一名20岁的患者,最初出现头痛和呕吐。增强的磁共振成像显示巨大的亚急性右颞枕室管膜下出血,具有肿块效应。在进一步探测之后,我们发现她因疑似异位妊娠破裂而接受剖腹探查术,后来证明是妊娠滋养细胞瘤。经进一步评价诊断绒毛膜癌伴脑转移。我们的案例系列强调了在具有ICH非典型特征的年轻女性中具有高指数怀疑的重要性。不同的临床情况凸显了诊断年轻女性的挑战。它还强调了血清β-hCG的关键作用,特别是在资源有限的环境中,活检不容易获得。建立这些不同表现的存储库对于增加怀疑指数并最终改善患者预后至关重要。
UNASSIGNED: In young women presenting with atypical features of intracerebral hemorrhage, metastatic choriocarcinoma should be considered as a differential diagnosis. In resource-poor settings, a high index of suspicion and serum β-hCG are crucial for diagnosis.
UNASSIGNED: Intracerebral hemorrhage in the young is rarely caused by metastatic choriocarcinoma. Diagnosis of this condition may be particularly challenging in resource-poor settings where access to diagnostic technologies may be limited. We present a
case series of three young females diagnosed with metastatic choriocarcinoma after initially presenting with intracerebral hemorrhage, each demonstrating unique clinical manifestations. We aim to highlight the diagnostic considerations in the management of this infrequently encountered cause of intracerebral hemorrhage, especially in resource-constrained settings.
Case 1 involved a 21-year-old woman who was initially diagnosed with intracerebral hemorrhage likely of tumoral origin from an unknown primary source. Further evaluation revealed extremely high levels of β-hCG and features suggestive of an intrauterine malignancy, which led to a diagnosis of metastatic choriocarcinoma. This further became complicated by pulmonary embolism. Unfortunately, she succumbed to respiratory failure during treatment.
Case 2 is a young woman who presented to the emergency unit and was managed as a
case of lobar intracerebral hemorrhage. Further checks revealed a previous history of hysterectomy done on account of placental site trophoblastic tumor, which promoted an evaluation for choriocarcinoma.
Case 3 involved a 20-year-old patient who initially presented with headache and vomiting. An enhanced magnetic resonance imaging showed a large subacute right temporal occipital subependymal hemorrhage with mass effect. After probing further, we discovered that she underwent exploratory laparotomy for suspected ruptured ectopic gestation, which later turned out to be a gestational trophoblastic neoplasia. After further evaluation a diagnosis of choriocarcinoma with brain metastasis. Our
case series emphasizes the importance of having a high index suspicion in young females who present with atypical features of ICH. The varied clinical scenarios highlight the challenges in diagnosing young females. It also underscores the critical role of serum β-hCG, especially in resource-limited settings where biopsies are not readily available. Building a repository of these diverse manifestations is essential for increasing the index of suspicion and ultimately improving patient outcomes.