Postpartum intracranial hemorrhage: Diagnostic and therapeutic insights into metastatic choriocarcinoma

• The diagnostic challenge of differentiating metastatic choriocarcinoma from primary intracranial hemorrhage in reproductive-aged women. • The critical importance of serum β-hCG testing in atypical neurological presentations. • The effectiveness of multimodal therapy combining neurosurgical intervention with prompt chemotherapy initiation. This case report describes a 19-year-old primigravida who presented with acute neurological symptoms three months post-delivery, ultimately diagnosed with cerebral metastatic choriocarcinoma complicated by intracranial hemorrhage. Diagnostic evaluation revealed elevated serum β-hCG (80678 IU/L), pulmonary metastases, and a hemorrhagic frontoparietal lesion on neuroimaging. Emergency hematoma evacuation confirmed choriocarcinoma through characteristic histopathological and immunohistochemical findings (CKp +, β-hCG + and H3K27me3 + ). The patient was classified as FIGO stage IV and successfully treated with EMA/CO chemotherapy, demonstrating biochemical response (β-hCG decline to 105 IU/L) without complications. This case highlights several key clinical insights: (1) the diagnostic challenge of differentiating metastatic choriocarcinoma from primary intracranial hemorrhage in reproductive-aged women; (2) the critical importance of serum β-hCG testing in atypical neurological presentations; and (3) the effectiveness of multimodal therapy combining neurosurgical intervention with prompt chemotherapy initiation. The temporal relationship to recent pregnancy (3 months postpartum) and rapid hematogenous spread underscore the aggressive nature of this trophoblastic malignancy. These findings reinforce current management guidelines while emphasizing the need for heightened clinical suspicion when evaluating young women with unexplained neurological deficits and a recent pregnancy history.