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Neurological picture
Cerebral metastasis of renal carcinoma mimicking venous haemorrhagic infarction
  1. G C Petzold1,
  2. J M Valdueza1,
  3. C Zimmer2
  1. 1Department of Neurology, Humboldt University, Berlin, Germany
  2. 2Department of Diagnostic Radiology, University of Leipzig, Germany
  1. Correspondence to:
 Dr G C Petzold;
 Department of Neurology, Charité Hospital, Humboldt University, Schumannstr. 20/21, 10098 Berlin, Germany; gabor.petzoldcharite.de

https://doi.org/10.1136/jnnp.2003.024166

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    Several months after nephrectomy for hypernephroma, a 52 year old woman developed acute demyelinating neuropathy. Paraneoplastic neuropathy was suspected and she was treated with intravenous immunoglobulins (IGs). On the first day of treatment, she had a secondarily generalised tonic-clonic seizure. Contrast enhanced CT revealed right parieto-occipital intracerebral haemorrhage (fig 1A–D). Angiography disclosed persisting cortical veins (fig 1E–F). Although IG therapy was stopped, the patient continued to deteriorate until her condition stabilized after two weeks. The preliminary diagnosis of immunoglobulin induced venous thrombosis with secondary haemorrhagic infarction was made and treatment with phenprocoumon and carbamazepine was initiated. MRI performed six months later showed a residual hyperintense lesion (fig 2A). Four years later, native CT …

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