Metastatic choriocarcinoma presenting as a haemorrhagic stroke in a young woman in a low resource setting

Abstract

A 24-year-old right-handed nulliparous female, with no known stroke risk factors was admitted in the stroke unit with a day's history of right sided dense hemiplegia and unresponsiveness. She had a preceding background history of intermittent cough with haemoptysis for 2 months and amenorrhea for 5-months. Her workup was significantfor a low Thyroid Stimulating Hormone (TSH), elevated T4, effusion on the left side on chest X ray and intracerebral haemorrhage on non-contrast Computed Tomography (CT) brain.  Subsequent imaging with a Magnetic Resonance Imaging (MRI) scan of the brain on day 3 post-admission revealed multiple intracerebral bleeds. A diagnosis of metastatic choriocarcinoma was made which was confirmed by a markedly elevated serum B-human chorionic gonadotrophin level. Quantitative serum B-chorionic gonadotrophin is recommended as an important investigation in young women of child bearing age presenting with hemorrhagic stroke.