# Solid brain metastasis mimicking intracerebral hematoma on imaging

## TL;DR

A patient with colon cancer had a brain metastasis that looked like a brain hemorrhage on imaging, leading to a rare and challenging diagnosis.

## Contribution

This case highlights the rare presentation of brain metastasis mimicking intracerebral hematoma on CT scans.

## Key findings

- The cerebellar lesion was surgically resected and confirmed to be a brain metastasis, not a hematoma.
- The metastasis appeared as a hyper-dense lesion on CT, resembling spontaneous intracerebral bleeding.
- This case emphasizes the importance of considering metastasis in patients with cancer presenting with brain lesions.

## Abstract

A 79-year-old woman with a history of resection of the ascending colon cancer presented with conscious disturbance, dysarthria, nausea, and dizziness. Computed tomography (CT) revealed striking high-density lesions in the left cerebellum and left frontal lobe with slight perifocal edema. These lesions were suspected the coexistence of spontaneous cerebellar hemorrhage and frontal lobe metastasis, or multiple brain metastases with massive hematoma. Because of the mass effect of the cerebellar lesion and impaired consciousness, she underwent emergency resection of the cerebellar lesion which was found to be composed of grayish abnormal soft solid tissue and did not include an obvious hematoma mass. The pathological findings were consistent with brain metastasis from colon cancer. This is an impressive rare case of intraoperative solid brain metastasis with a clearly homogenous hyper-dense CT appearance mimicking intracerebral hematoma.