AN INTERESTING PATIENT WITH PARTIAL SEIZURES

Abstract

Intracranial neoplasms usually produce
an insidious onset focal neurological deficit,
though a sudden onset is not uncommon
and is due to hemorrhage within a
tumour, tumour embolism, or an embolism
from non thrombotic endocarditis. A
similar presentation was seen in a 27
year old female with 40 days amenorrhoea
who presented with new onset
simple partial seizures involving right upper
limb and acute onset right faciobrachial
monoplegia followed by bleeding
per vaginum. She had
attained menarche at 17 years of age
and had a history of termination of pregnancy
4 months back after a period of 4
months amenorrhoea details of which
were not available at the time of presentation.
She had no history suggestive of
rheumatological or hematological disorders.
Her menstrual cycles were normal
since menarche. Complete hemogram,
Renal function test,Bleeding time,Clotting
time, PT, APTT were within normal limits.
Chest X ray, ultrasonogram abdomen
were found to be normal. CT brain
showed multiple intraparenchymal haemorrhage
with surrounding edema in left parietal
region..MRI brain showed ill defined areas
of T1 hyperintensity in left frontoparietal
region,areas of T2 hypointensity, blooming
on gradient sequences, and not suppressed
in FLAIR sequences with a normal
MRA and MRV.ANA, Protein C, Protein S,
S.Homocysteine were found to be normal.
HIV ELISA, VDRL, HbsAg, Anti HCV
were found to be negative. A review of obstetric
history with previous records after
two days which suggested a previous hydatiform
mole and a raised serum Beta
HCG found subsequently suggested the
possibility of choriocarcinoma with brain
metastasis. CSF Beta hCG was raised indicating
possible brain metastasis. She was
treated with chemotherapy (EMA-CO regimen)
and radiotherapy for brain metastases
along with intrathecal Methotrexate
which was followed by remission. This
case is presented due to the uncommon
nature of presentation of choriocarcinoma
and due to the rare occurrence of brain
metastasis without lung secondaries.