Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma

Lee, Chang Sub; Huh, Ji Soon; Sim, Ki-Bum; Kim, Youn Woo

doi:10.1007/s00381-008-0678-5

Cited by 23 publications

(16 citation statements)

References 14 publications

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“…A particular clinicopathological presentation of PAs might be associated with fatal haemorrhages, which are most often subarachnoid (SAH) [34,46,54,61,64]. Such tumour manifestation is less commonly observed in PMA [35,89].…”

Section: Prognosismentioning

confidence: 99%

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

Matyja

Grajkowska²,

Stępień³

et al. 2016

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Section: Prognosismentioning

confidence: 99%

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

Matyja

Grajkowska²,

Stępień³

et al. 2016

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“…Once considered an infrequent occurrence, 8,21,23 spontaneous hemorrhage in PAs has become more recognized 1,9,11,12,15,19,24 and can present as an acute neurosurgical emergency. In a retrospective review of 138 cases of PAs, White et al 24 reported that 8% of their patients had a concurrent hemorrhage at presentation as assessed by CT and MRI and confirmed by pathological examination of the resected tumor.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic presentations of cerebellar pilocytic astrocytomas in children resulting in death: report of 2 cases

Wilson

Johnson²,

Hawkins

et al. 2016

PED

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Acute hemorrhagic presentation in pilocytic astrocytomas (PAs) has become increasingly recognized. This type of presentation poses a clinically emergent situation in those hemorrhages arising in PAs of the cerebellum, the most frequent site, because of the limited capacity of the posterior fossa to compensate for mass effect, predisposing to rapid neurological deterioration. As examples, we describe two cases of fatal hemorrhagic cerebellar PAs: one of a child with a slowly growing stereotypical WHO Grade I PA with a 1-year period of symptomatology that preceded a rapid clinical deterioration, and another of an asymptomatic child having a PA variant, presenting with progressive obtundation following a presumed Valsalva event. These two scenarios parallel previous reports in the literature of either a setting of progressive expression of cerebellar dysfunction and transient episodes of raised intracranial pressure (ICP), or abrupt onset of features of increased ICP in a previously well child. The literature is further reviewed for a current understanding of the factors that predispose, initiate and propagate bleeding, with specific reference to the role of vascular endothelial growth factor and other angiogenic agents in the genesis and stability of the vasculature in PAs. In this context, we propose that obliterative vascular mural hyalinization with associated altered flow dynamics and microaneurysm formation was the pathogenesis of the hemorrhage in our first case. In the second case, large tumor size, increased growth rate, looseness of the background myxoid matrix, and thinness of the tumor blood vessels with calcospherite deposition predisposed to vascular leakage and bleeding concurrent with sudden increases in intravascular hydrostatic pressure. In that cerebellar PAs are common, this report underscores the importance of considering in the differential diagnosis the possibility of a spontaneous hemorrhage in a posterior fossa PA in a child presenting with a sudden neurological ictus and raised ICP.

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“…described a case of a hemorrhagic cerebellar pilocytic astrocytoma in a 15-month-old boy [6]. Lyons reported on a case of a spontaneous intracerebral hemorrhage in association with a pilocytic astrocytoma in a 75-year-old man [8].…”

Section: Discussionmentioning

confidence: 99%

“…We aim to present the case of an adult harboring a posterior fossa pilocytic astrocytoma presenting in an acute fashion with a rapidly deteriorating neurological exam after spontaneous intratumoral hemorrhage. Cases of hemorrhagic presentation of these tumors have been reported in the literature [1][2][3][4][5][6][7][8][9][10][11], although they are quite rare. The vast majority of pilocytic astrocytomas are not associated with hemorrhage, leading one to infer that a small sub-population of these tumors may have inherent features making them more susceptible to hemorrhagic complications.…”

Section: Introductionmentioning

confidence: 99%

Acute Neurological Deterioration in an Adult with a Cerebellar Pilocytic Astrocytoma Accompanied by Intratumoral Hemorrhage, Subdural Hematoma, and Obstructive Hydrocephalus

Galgano¹,

Padalino²,

Fullmer³

et al. 2014

Cureus

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Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma

Abstract: The authors' case is the first report with a presentation including ITB, SAH, and SDH. The presumed mechanism of the SAH and SDH was leaking of the ITB into subarachnoid and subdural spaces.

Cited by 23 publications

References 14 publications

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

Heterogeneity of histopathological presentation of pilocytic astrocytoma – diagnostic pitfalls. A review

Hemorrhagic presentations of cerebellar pilocytic astrocytomas in children resulting in death: report of 2 cases

Acute Neurological Deterioration in an Adult with a Cerebellar Pilocytic Astrocytoma Accompanied by Intratumoral Hemorrhage, Subdural Hematoma, and Obstructive Hydrocephalus

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