Nineteen patients with nervous system metastasis of hepatocellular carcinoma (HCC) were evaluated retrospectively. Nervous system metastasis was frequently initial presentation of HCC (seven out of 19 patients). Seven patients had metastases of the brain, of whom four had a stroke-like presentation. CT or MRI in these patients showed intracerebral hematomas in watershed areas. Enhancing lesion or edema adjacent to the hematoma helped differentiate these lesions from classical hypertensive hematomas. One patient with metastasis to the clivus presented with isolated six nerve palsy. The remaining 11 patients had spinal epidural metastases producing myelopathy in seven and radiculopathy in four. Radiation therapy failed to control the clinical course.