Fatal cerebellar hemorrhage as an initial presentation of medulloblastoma in a child

Abstract

Children with medulloblastomas most commonly present with signs and symptoms of elevated intracranial pressure due to obstructive hydrocephalus, especially headaches and vomiting. However, some pediatric patients present with sudden neurological deterioration due to intracerebellar hemorrhage associated with medulloblastoma, although very few reports exist that document this phenomenon. An 8-year-old girl was admitted to our emergency department who presented with sudden loss of consciousness, vomiting, and bradycardia. The neuroradiological evaluation revealed a hemorrhagic mass lesion in the posterior fossa. Urgent evacuation of the hematoma was performed. The postoperative course was uneventful, and the postoperative histopathological examination revealed the lesion to be a medulloblastoma. This report presents an unusual case of a medulloblastoma presenting with fatal intracranial hemorrhage in a child. The clinical features and intraoperative and pathologic findings of the case are discussed.

Keywords: Cerebellar hemorrhage; childhood; medulloblastoma.

Figure 1

(a) Computerized tomography scan of the brain performed at admission, showing intracerebellar hemorrhage. (b) Postoperative computerized tomography image reveals successful evacuation of the lesion

Figure 2

Histological examination of the resected hemorrhagic mass. (a) Necrotic and hemorrhagic tumor tissue consistent with medulloblastoma (H and E, ×40). (b) Highly cellular tumor tissue was composed of primitive neuroepithelial cells; necrosis was present (H and E, ×100). (c) Numerous tumor cell nuclei stained positive with the Ki-67 monoclonal antibody (Anti-Ki-67, ×400)