Pediatric primary intraventricular hemorrhage: A case report of isolated fourth ventricle hemorrhage in a 10-year-old boy

Abstract

Key clinical message: Primary intraventricular hemorrhage (PIVH) is a rare condition in pediatric patients, presenting with headache, vomiting, and altered mental status. Surgical interventions, such as external ventricular drain placement, followed by ventriculoperitoneal shunting, show promising outcomes. Further research is needed to enhance understanding and optimize management strategies for pediatric PIVH.

Abstract: This case report describes a 10-year-old boy with isolated primary intraventricular hemorrhage (PIVH) in the fourth ventricle, shedding light on its clinical presentation and management challenges. The patient presented with headache, vomiting, and altered sensorium, and was subsequently diagnosed with obstructive hydrocephalus due to intraventricular bleeding. Emergency external ventricular drain (EVD) insertion was performed, followed by ventriculoperitoneal shunt placement, resulting in a favorable outcome. The etiology of PIVH in children differs from that in adults, with arteriovenous malformations, Moyamoya disease, and aneurysms being commonly implicated causes. Management strategies for pediatric PIVH are challenging due to limited research, but EVD placement and surgical interventions have shown promise.

Keywords: external ventricular drain; pediatric intraventricular hemorrhage; pediatric neurosurgery; ventriculoperitoneal shunt.

FIGURE 1

(A) Magnetic resonance imaging (MRI) showing isolated hemorrhage in the fourth ventricle. (B) CT scan showing a hyperdense area of blood density noted within the fourth ventricle, likely intraventricular hemorrhage. Upstream dilatation of bilateral lateral and third ventricle is noted, possibly due to the obstructive hydrocephalus. (C) Susceptibility weighted image showing blooming foci in the fourth ventricle. (D) T1‐weighted image showing hyperintense area within the fourth ventricle. (E, F) CT scan taken after ventriculoperitoneal shunt showing EVD tube in situ with tip in the right lateral ventricle. Mild hydrocephalus (reduced) seen.

FIGURE 2

(A, B) CT angiogram taken after resolution of bleed 2 months after discharge.