title: Undiagnosed medulloblastoma presenting as fatal hemorrhage in a 14-year-old boy: case report and review of the literature.
abstract: BACKGROUND
  A 14-year-old boy with no significant medical history presented to the emergency room with a sudden onset of severe headache of 1 day's duration. On admission, a non-contrast computed tomography (CT) of the head showed a posterior fossa hemorrhagic mass.
  
  
  METHODS
  He was immediately intubated and underwent placement of an external drainage tube. A magnetic resonance imaging (MRI) was performed, which showed a large hemorrhagic mass with upward cerebellar herniation.
  
  
  RESULTS
  Despite aggressive measures, he deteriorated and was pronounced brain dead 2 days after admission. Pathological examination of the mass revealed a medulloblastoma with extensive neuronal and astrocytic differentiation.
  
  
  CONCLUSIONS
  This case represents one of the few cases of rapid, hemorrhagic expansion associated with a previously undiagnosed medulloblastoma. The topic of hemorrhage due to previously unrecognized brain tumors is discussed and the value of imaging methods used in the diagnostic assessment is emphasized.
authors.affiliation: Division of Pathology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Mariarita
authors.initials: M
authors.lastname: Santi
authors.forename: Nadja
authors.initials: N
authors.lastname: Kadom
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Rushing
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000150:complications* / Q000473:pathology; D014057:Tomography, X-Ray Computed