Abstract
BACKGROUND: Although choriocarcinoma can metastasize to the brain, it is extremely rare for it to present with multiple types of metastatic lesions simultaneously. OBSERVATIONS: A 32-year-old primiparous woman presented with acute left-sided hemiparesis. Imaging revealed multiple intracranial and systemic lesions, including a hemorrhagic lesion with spindle-shaped vasodilatation, a dural mass, a brain parenchymal lesion, and a lung tumor. Craniotomy was performed on the dural lesion and dilated cerebral vessels, leading to the diagnosis of dural metastasis and a neoplastic cerebral aneurysm (NCA) secondary to choriocarcinoma. The patient underwent multidrug chemotherapy, which resulted in the complete resolution of all lesions. Pathological analysis confirmed that both the dural metastasis and the NCA were characterized by tumor cell invasion of vascular structures. LESSONS: Choriocarcinoma can present with various types of brain metastases. In this case, both dural metastasis and NCA arose from tumor cell thrombosis, with variations in pathology likely influenced by differences in vascular structures. https://thejns.org/doi/10.3171/CASE2564.