A Case of Intracranial Melanoma Metastasis Presenting with Arteriovenous Shunting

Abstract

Rakesh Danny Biju, Arjun S Chandran, Amal Abou Hamden and Rebecca Scroop

Melanoma metastases to the brain are highly vascular lesions and have a high predilection to haemorrhage. Due to their degree of vascularity, these lesions sometimes demonstrate arteriovenous shunting. They may even mimic separate entities such as arteriovenous malformations (AVM). We present one such case; a 32-year-old male who was transferred to our unit with acute left sided hemiparesis and slurred speech. Imaging demonstrated a large intracerebral haemorrhage (ICH) with arteriovenous shunting and presumed underlying AVM. This was initially managed conservatively, however progressive neurological decline over subsequent days necessitated surgical intervention and the hematoma was evacuated. An arterialised vein and nidus of abnormal vessels were identified intra-operatively and disconnected from feeding MCA vessels. There were no macroscopic appearances suggestive of a melanoma. The final diagnosis of metastatic melanoma was only made on histopathological analysis of the resected specimen. This case highlights the importance of sending all ICH samples for histopathological analysis regardless of appearances on imaging.

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