A 78-year-old female presented with swelling and severe pain in the left forehead secondary to a simple head injury received 1 month previously. On admission, neurological examination was normal. Plain skull x-ray films and computed tomography showed an osteolytic and well-defined mass in the left frontal bone. Bone scintigraphy showed high-uptake areas in the right lower ribs and fifth lumbar vertebra. Blood tests showed slight liver dysfunction and a high alpha-fetoprotein level. Abdominal computed tomography showed a huge mass within the liver. Left common carotid angiography disclosed the enlargement of several feeding arteries arising from the external carotid artery with tumor staining. The bone tumor was removed for histological diagnosis and to reduce the localized pain. The histological diagnosis was a cranial metastasis from hepatocellular carcinoma. She died of ruptured varicose veins of the esophagus approximately 8 months after surgery. Surgery for cranial metastasis from hepatic cancer is only indicated when localized pain or hemorrhage threaten the quality of life.
We report 2 cases of ruptured aneurysms of the distal posterior inferior cerebellar artery (PICA)and review 85cases reported in the literature . Case 1 :A72 . − year − old man had headaches . Cornputed tornography (CT)revealed intraventricular hemorrhage (IVH)and hydrocephalus without subarachnoid hemorrhage (SAH) . Cerebral angiography showed an a1 ユeurysm located on the telovelo − tonsmar seglnent of the left PICA . The aneurysm ruptured again during angiography , causing the patient ' s death. Case 2 :A72 −. year − old man experienced disturbance of consciousness , CT revealed SAII and IVH with hydrocephalus , Cerebral angiography showed an aneurysm Iocated on the tonsillo − medullary segment of the left PICA . The aneurysrn was clipped successfully and the patient underwent ventriculo − per{ toneal shunting . The postoperative course was uneventful , Whereas angiography in Case 工showed that the aneurysm had bled through the roof of the fourth ventricle and into the ventricle but showed nQ apparent SAH , the surgicaI findings in Case 2 suggested that intracisternal blood had entered the ventricle . These contrasting findings indicate that the pathology of IVH varies among different segments of the PICA . Review of the literat しlre revealed that the incidence of IVH after the rupture of aneuryslns of the distal PICA is 55 % , In the case of the telovelo − tonsillar segment , the incidence is 7/% , which is clearly higher than that for other segments of the PICA. The outcome of distal PICA aneurysms in rep 〔 , rted series is good in 72, 4 % of patients. 1▽H alone is not necesSarily a factor affecting the prognosis of distal PICA aneurysms , but when compliCated by hN ・ droCephalus tends to worsen the prognosis.
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