Brain metastasis and herniation in a patient with ampullary adenocarcinoma presenting with jaundice and memory loss: case report

Periampullary carcinoma includes neoplasms arising from head of pancreas, distal common bile duct, duodenum and ampulla of Vater. We report a case of a 41-year-old male, medically free who presented to our hospital as a case of obstructive jaundice, weight loss, headache and blurred vision. Clinical evaluation revealed memory loss and ataxia. Endoscopic retrograde cholangiopancreatography (ERCP) was carried out and showed a mass in the ampullary area, histopathology showed ampullary adenocarcinoma. Metastatic work up was carried out which revealed two brain metastatic lesions and multiple intra-abdominal metastasis. We are reporting the third case of brain metastasis from ampullary adenocarcinoma. It metastasizes commonly intra-abdominally, but extra-abdominal metastases are rare yet it should be included in the differential diagnosis of patients with a history of ampullary carcinoma who present with neurological symptoms. There are no current specific management guidelines for brain metastasis secondary to ampullary adenocarcinoma, so general brain metastasis management is applicable.