Silent renal malignancy revealed by refractory headache: Case report of brain-metastatic clear-cell renal cell carcinoma and literature review

A chronic headache is rarely the initial symptom of metastatic renal cell carcinoma. In our 54-year-old patient, a treatment-resistant headache resulted in an MRI of the brain, which revealed a solitary 10-mm lesion. A subsequent thoraco-abdominal-pelvic CT scan identified a 5-cm primary tumor in the right kidney. A biopsy confirmed that the primary tumor was a grade 3 clear cell renal cell carcinoma. In uncommon situations, cerebral metastasis can appear before any clinical signs of the primary tumor. We describe the case of a patient with an incidental, previously unrecognized renal carcinoma, whose initial presentation consisted of persistent headaches.