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Marcus Yountz, MD; Manu Mehdiratta, MD, FRCPC; Louis R. Caplan, MD

Arch Neurol. 2007;64(11):1659-1660.

Objective  To describe a patient with a predominantly unilateral intracranial arterial stenosis who then developed metastatic lung cancer to the brain, with the tumors preferentially depositing in the underperfused cerebral hemisphere.

Design  Case report.

Setting  Inpatient neurology ward at a university medical center.

Patient  A 68-year-old woman with intracerebral arterial stenosis who then developed lung cancer with multiple metastases to the brain in an asymmetric arrangement.

Main Outcome Measure  The location of metastatic tumor deposits in relation to intracerebral arterial stenosis in the cerebral hemispheres of our patient.

Results  In this patient, most of the metastatic tumors were located in the underperfused cerebral hemisphere.

Conclusions  This case demonstrates the concept that emboli washout by vigorous circulation is more important than direct delivery of embolic material in determining whether tumor cells will implant and grow in the brain.

Author Affiliations: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

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