Hemorrhagic brain metastasis as the initial presentation of osteosarcoma: a rare case report

Osteosarcoma is the most common malignant bone tumor in children and adolescents, with a predilection for long bones and frequent pulmonary metastases. Brain metastases are rare, occurring in 1.8% to 5.6% of cases, and hemorrhagic ones are exceptionally uncommon, with only a few cases documented in the literature. We report the case of a 16-year-old girl who presented with acute headache and seizures. Imaging revealed hemorrhagic brain and pulmonary metastases, and biopsy confirmed a primary femoral osteosarcoma. This case represents an exceptionally rare presentation of osteosarcoma and highlights its aggressive metastatic behavior.