title: Intracranial chordoma presenting as acute hemorrhage in a child: Case report and literature review.
abstract: BACKGROUND
  Chordomas are rare, slow-growing malignant neoplasms derived from remnants of the embryological notochord. Pediatric cases comprise only 5% of all chordomas, but more than half of the reported pediatric chordomas are intracranial. For patients of all ages, intracranial chordomas typically present with symptoms such as headaches and progressive neurological deficits occurring over several weeks to many years as they compress or invade local structures. There are only reports of these tumors presenting acutely with intracranial hemorrhage in adult patients.
  
  
  METHODS
  A 10-year-old boy presented with acute onset of headache, emesis, and diplopia. Head computed tomography and magnetic resonance imaging of brain were suspicious for a hemorrhagic mass located in the left petroclival region, compressing the ventral pons. The mass was surgically resected and demonstrated acute intratumoral hemorrhage. Pathologic examination was consistent with chordoma.
  
  
  CONCLUSIONS
  There are few previous reports of petroclival chordomas causing acute intracranial hemorrhage. To the authors' knowledge, this is the first case of a petroclival chordoma presenting as acute intracranial hemorrhage in a pediatric patient. Although uncommon, it is important to consider chordoma when evaluating a patient of any age presenting with a hemorrhagic lesion of the clivus.
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16 Street, Suite 5100, Indianapolis, IN, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Moore
authors.affiliation: Department of Neurosurgery, Oklahoma University Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK 73104, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Bohnstedt
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Room A-128, Indianapolis, IN, USA.
authors.forename: Sanket U
authors.initials: SU
authors.lastname: Shah
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Room A-128, Indianapolis, IN, USA.
authors.forename: Marwah M
authors.initials: MM
authors.lastname: Abdulkader
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Room A-128, Indianapolis, IN, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Bonnin
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16 Street, Suite 5100, Indianapolis, IN, USA.
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Ackerman
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16 Street, Suite 5100, Indianapolis, IN, USA.
authors.forename: Kashif A
authors.initials: KA
authors.lastname: Shaikh
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 714 N. Senate Ave, Suite 100, Indianapolis, Indianapolis, IN, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Kralik
authors.affiliation: Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 16 Street, Suite 5100, Indianapolis, IN, USA.
authors.forename: Mitesh V
authors.initials: MV
authors.lastname: Shah
keywords: Chordoma; children; intracranial hemorrhage