Key result
Hemorrhagic melanoma metastasis develops at the exact site of a prior ischemic stroke 16 years later.
Why the study?
Ischemic stroke and tumors cause significant death and disability, and brain metastases can manifest in patients with both malignancy and prior ischemic stroke.
Case Report (n=1)
No
This case report highlights the rare occurrence of brain metastasis localizing to the exact region of a prior ischemic stroke, suggesting infarcted tissue may provide a favorable microenvironment for tumor seeding.
May warrant targeted surveillance at prior infarct sites in melanoma; hypothesis-generating for infarcted tissue as tumor niche.
BACKGROUND: Ischemic stroke and tumor account for a disproportionate share of deaths and disabilities among the elderly. Patients with a tumor who develop recurrent acute neurological deficits after a stroke can be at risk for tumor-related stroke. In contrast, brain metastases (BM) are common causes of neurological symptoms and are associated with a poor prognosis in patients with both malignancy and ischemic stroke. OBSERVATIONS: The authors report a rare case of metastatic melanoma that manifested in the same region as a previous ischemic infarction. A 22-year-old female presented at our emergency department with right hemiparesis and sensory difficulties. Infarction in the left frontoparietal and basal ganglia regions was found on a computed tomography scan of the brain. A decompressive hemicraniectomy was performed urgently. After 16 years, a biopsy taken from her chin revealed malignant melanoma. Hemorrhagic metastasis on the frontal lobe of the brain was detected with magnetic resonance imaging and was histopathologically confirmed upon resection. LESSONS: In addition to recurrence, BM may be considered when a person with ischemic stroke and a cancer such as melanoma has new neurological problems in one area that cannot be explained by the stroke.
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Atallah et al. (2023) conducted a case report in Brain metastasis and ischemic stroke (n=1). Surgical resection was evaluated. A 22-year-old female developed a hemorrhagic brain metastasis from malignant melanoma in the exact same region as a previous ischemic infarction 16 years prior.
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