Juvenile pilocytic astrocytoma presenting with subarachnoid hemorrhage (original) (raw)

2004, Journal of Neurosurgery: Pediatrics

ILOCYTIC astrocytoma is a very rare cause of tumorrelated SAH and has been previously reported in only six cases. 1,3,4,6,10,16 Brain tumors have been reported to be responsible for 3 to 7% of SAH or intracerebral hematoma in the pediatric population. 12,13,15 Medulloblastomas and other primitive neuroectodermal tumors are the most common source. In cases of supratentorial pilocytic astrocytoma arising from the opticochiasmatic/hypothalamic axis, patients usually present with visual impairment, endocrine abnormalities, and diencephalic syndrome. 2 Hemorrhage in cases of JPA is very rare. 1,3, 4,6,10,16 We describe the case of a 13-year-old boy who presented with SAH due to a chiasmatic/hypothalamic pilocytic astrocytoma. Case Report History. This 13-year-old boy developed sudden onset of headache, vomiting, and loss of consciousness. He was immediately taken to a local hospital where cranial CT scanning demonstrated blood in the basal cisterns and the third ventricle (Fig. 1). He regained consciousness after 6 hours and was referred to our institution for further treatment. Presentation and Examination. We learned that the patient had a 2-month history of episodic headaches. On examination, he was alert and his higher mental function status was normal. He had neck rigidity and a positive Kernig sign was evident. Visual acuity was 6/36 on the left and 6/6 on the right side. Bilateral fundi were normal. He had right temporal and left nasal field cuts. The cranial nerve's functions were intact. There was no history of polyuria or endocrinopathy. Routine hematological workup demonstrated normal levels, and the coagulation profile was normal as well. Angiography revealed upward displacement of the A 1 segments of the ACA bilaterally (Fig. 2). No associated aneurysm or vascular malformation was seen. Cranial MR imaging revealed a large suprasellar mass in the chiasmatic/hypothalamic region with evidence of hemorrhage (Fig. 3A and B). After contrast administration the mass showed peripheral enhancement (Fig. 3C and D). The pituitary gland was seen to be separate from the mass. Operation. A left pterional craniotomy was performed. The tumor was approached via intraoptic and caroticooptic spaces. The subarachnoid space was filled with blood. We observed a grayish mass that was soft and easily suctioned. Large blood clots were seen within the substance