title: Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma.
abstract: BACKGROUND
  Massive intracranial hemorrhage is a very rare initial presentation of cerebellar pilocytic astrocytomas. There are no reports in the medical literature on a cerebellar pilocytic astrocytoma presenting with intratumor bleeding (ITB), subarachnoid hemorrhage (SAH), and subdural hematoma (SDH).
  
  
  METHODS
  A 15-month-old boy presented with lethargy and nausea to our hospital. Magnetic resonance imaging showed a mass with ITB at the left cerebellar hemisphere in addition to SDH in the posterior fossa and SAH at the interpeduncular cistern. The patient underwent emergency surgery. On incising the dura, we found SDH, the tumor was visible at the cerebellar cortex, and near total removal followed. Microscopic examination of tissue sections revealed a pilocytic astrocytoma.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Cheju National University Hospital, 154, Samdo2dong, Jeju City, Jeju, 690-716, South Korea. nschangsub@yahoo.co.kr
authors.forename: Chang Sub
authors.initials: CS
authors.lastname: Lee
authors.forename: Ji Soon
authors.initials: JS
authors.lastname: Huh
authors.forename: Ki-Bum
authors.initials: KB
authors.lastname: Sim
authors.forename: Youn Woo
authors.initials: YW
authors.lastname: Kim
mesh_terms: D001254:Astrocytoma / Q000150:complications* / Q000175:diagnosis; D002528:Cerebellar Neoplasms / Q000139:chemically induced / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D006408:Hematoma, Subdural / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome