Slide 1: What’s the diagnosis?

Slide 2: Hemorrhagic Brain Metastasis. One. Multiple parenchymal hemorrhages with surrounding edema. Two. Notice the cortex (outermost layer of the brain) is spared in all regions of hemorrhage (teal lines). CT scan shown with arrows pointing to edema and spared cortex. Blood appears as layering hyper-dense white areas on CT scan. Edema appears as areas of hypo-attenuation (see arrows) on CT scan. This patient had a history of renal cell carcinoma, which is a type of cancer notorious for bleeding metastatic disease.

Slide 3: How can we differentiate hemorrhagic tumor from other types of hemorrhage?

Hemorrhage type. Tumor. Location. Grey/white junction. Involves the cortex. No. Single or multiple. Multiple. Specific findings. Lots of surrounding edema.

Hemorrhage type. Hemorrhagic conversion of stroke. Location. One vascular territory. Involves the cortex. Always. Single or multiple. Usually on one. Specific findings. Confined to a vascular territory of the brain.

Hemorrhage type. Contusion. Location. In the vector of trauma (look beneath scalp hematomas). Involves the cortex. Yes/No. Single or Multiple. Either single or multiple. Specific findings. Will see other evidences of trauma.

Graphic showing tumor vs stroke vs contusion (arrow showing vector of trauma).

Slide 4: Brain metastasis takeaways. Hemorrhagic metastasis features. One. Have a lot of surrounding edema. Two. Spare the cortex and are centered at the grey/white junction. Three. Often multifocal, because they spread to the brain via blood vessels (hematogenous spread).

Check out some of the primary tumors that often produce hemorrhagic metastases: melanoma, lung carcinoma, hepatocellular carcinoma, thyroid carcinoma, breast carcinoma, renal cell carcinoma, and choriocarcinoma.

If a patient has a history of any of these cancers, be suspicious for hemorrhagic metastatic disease!

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