Primary Anal Squamous Cell Carcinoma With Metastasis to the Brain Presenting As Stroke-Like Symptoms in a 27-Year-Old Patient

Metastatic squamous cell carcinoma (SCC) with spread to the brain is a rare entity in primary anal SCC. These findings are especially unusual in a young, HIV-negative patient. We present a case of a 27-year-old woman with metastatic SCC of the anus, previously treated with pelvic radiation and chemotherapy, who presented with acute right-sided weakness mimicking stroke-like symptoms. Neuroimaging revealed multifocal bilateral enhancing lesions consistent with metastatic brain disease. Symptoms resolved following treatment of the vasogenic edema secondary to brain metastasis. This case highlights the unique finding of primary anal SCC with metastasis to the brain in a young, HIV-negative, human papillomavirus type 16 (HPV 16)-positive patient. It further underscores the importance of preventative care with HPV vaccinations to prevent HPV 16 and 18, as well as brain imaging to rule out intracranial metastases in patients with malignancies presenting with new neurological deficits.