Choriocarcinoma presenting as Jacksonian epilepsy

Area of Science:

• Neurology
• Oncology
• Gynecology

Background:

• Cerebral choriocarcinoma metastases are typically multiple and associated with a poor prognosis.
• Diagnosis can be challenging, especially when initial tests for pregnancy and uterine malignancy are negative.

Observation:

• Two patients presented with Jacksonian epilepsy secondary to metastatic choriocarcinoma in the brain.
• The first patient had an unsuspected diagnosis, confirmed only by brain biopsy shortly before death.
• The second patient, previously treated for uterine and pulmonary choriocarcinoma, presented with neurological symptoms despite undetectable urinary human chorionic gonadotrophin.

Findings:

• Brain biopsy confirmed choriocarcinoma in the first patient.
• Brain scan revealed multiple metastatic lesions in the second patient.
• The second patient achieved complete remission with a combination of systemic chemotherapy, intrathecal methotrexate, and cranial irradiation.

Implications:

• Intrathecal methotrexate combined with cranial irradiation represents a potentially effective therapeutic strategy for metastatic cerebral choriocarcinoma.
• This approach may improve outcomes for patients with brain metastases from this rare malignancy.