Extra Skeletal Ewing’s sarcoma presented with focal seizure and hemorrhagic stroke-like table: A case report

Extra skeletal Ewing's sarcoma(EES) is a rare tumor originating from non-bone tissues and consisting of small round cells with a fragment or lobular distribution. What is known about the central nervous system (CNS) metastases of EES is extremely limited. Our case, which was not diagnosed before and initially presented with neurological symptoms and CNS involvement, is the first case in the literature. We aimed to contribute to the literature through this case. A 26-year-old male patient was admitted to the emergency department with sudden headache, weakness on the right side and involuntary fast clonic contractions localized in the right arm and leg. Computed tomography (CT) revealed hemorrhagic appearance in the left frontoparietal region, upon which the patient was hospitalized with a preliminary diagnosis of hemorrhagic stroke. The patient had complete clinical recovery and his focal seizure was under control. After two weeks, the patient presented to the emergency department again with a complaint of headache. CT revealed hemorrhage-consistent appearance in the right parietal region. Mass lesions accompanied by edema sites and intravenous contrast enhancement were detected around hemorrhagic lesions in both hemispheres in magnetic resonance imaging (MRI). In the following days MRI examination of the left leg was performed due to pain and swelling in the left thigh. A mass lesion was detected in the left thigh. The patient was diagnosed with ES as a result of the histopathological examination and evaluated as having EES. Neurological findings can be seen in many malignant diseases as a result of both solid involvement and paraneoplastic processes. It should be kept in mind that even in patients who have not yet been diagnosed, neurological findings can be observed, which can facilitate the primary diagnosis.