Brain metastasis localized to the same area of infarction: illustrative case

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.

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.

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.