A Rare Case of Multiple Cranial Nerve Palsies as the First Presentation of Hepatocellular Carcinoma: A Case Report and Review of Literature

Abstract

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It mainly occurs in patients with chronic liver diseases such as cirrhosis caused by hepatitis B or C infections, as well as chronic alcoholics. HCC is one of the highly malignant neoplasms. Extrahepatic metastases are seen in 64% of patients with HCC, but metastases to the brain and skull are extremely rare. Here, the case of a 45-year-old male who presented with left III, IV, VI, IX, X, and XII cranial nerve palsies is reported. These were revealed to be caused by a distant metastasis from an unnoticed HCC with a background of previously undiagnosed chronic alcoholic liver disease. Physicians should be aware of the metastatic potential of HCC, in addition to its uncommon presentations, while encountering patients with an underlying liver disease. This case report demonstrates that metastatic HCC can lead to a rare, but possible, new onset of cranial neuropathy.