AN INTERESTING PATIENT WITH PARTIAL SEIZURES

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.