Hemorrhagic metastatic intracranial neoplasms: clinical-computed tomographic correlations.

Twenty patients with peritumoral hemorrhagic metastatic neoplasms are analyzed. The primary neoplasms included malignant melanoma, bronchogenic carcinoma, and hypernephroma. Six were solitary lesions and 14 were multiple metastatic lesions; however only 5 showed multiple hemorrhagic lesions. Only 10% of patients had coagulation disorders and none had a recent history of trauma. In 16 patients the onset of symptoms was sudden and in 4 patients there was rapid clinical deterioration within 5-8 days. Eleven patients initially had seizures. In all cases, CT scan showed a hyperdense lesion which was consistent with hemorrhage within the lesion and there was contrast enhancement. Three patients with solitary lesions underwent craniotomy and had surgical removal of the hemorrhagic metastatic neoplasm, but these patients did not receive postoperative irradiation. They died 6-14 months later without clinical evidence of neurological recurrence. The other patients with solitary or multiple hemorrhagic metastatic lesions neurologically deteriorated despite high dosage corticosteroid medication and they died within 2 months of the initial diagnosis being established by CT scan findings.