HCC without cirrhosis metastasizing to the clivus

The initial presentation of hepatocellular carcinoma (HCC) as a cranial nerve palsy is exceedingly rare. A lack of cirrhosis and elevated AFP in metastatic HCC is also uncommon. To our knowledge, this is the first case report of HCC presenting with ageusia without prior evidence of liver pathology. A 65-year-old man was admitted to our hospital for dysphagia. Over months, he had noticed 36 kg weight loss, dysphagia, ageusia, and horizontal diplopia. He had a low AFP, no evidence of cirrhosis, and no symptoms of liver pathology. On brain magnetic resonance imaging, he was found to have a mass in the clivus. On biopsy, metastatic HCC was diagnosed. HCC can be fatal if not recognized early. It rarely causes neurologic complications through metastasis to the skull. It is important to understand the localization of lesions to the clivus and include internal malignancy in creating a differential for cases of neurologic complaint.