Hemorrhagic intracranial metastases

Hemorrhagic intracranial metastases are considered to represent between 3-14% of all cerebral metastases (cf. 1-3% of gliomas are hemorrhagic).

These classically originate from:

• melanoma
• renal cell carcinoma
• choriocarcinoma
• thyroid carcinoma: papillary carcinoma of the thyroid has the highest rate of hemorrhage
• lung carcinoma: given the sheer number of cases, even though atypical for these primaries they are, nonetheless, common
• breast carcinoma: as for lung
• hepatocellular carcinoma
• hepatoblastoma (rare) ⁶
• osteogenic sarcoma (rare) ⁷

These can be recalled with the mnemonic MR CT BB.

Differential diagnosis

• primary hemorrhagic brain tumor, e.g. glioblastoma with hemorrhage (in the case of a single metastasis)
• primary lobar hemorrhage
• hemorrhagic transformation of an ischemic infarction