title: Synchronous Subarachnoid Aneurysmal Hemorrhage and Medulloblastoma in a 6-Year-Old Girl.
abstract: BACKGROUND
  Hemorrhage in medulloblastoma (MB) is a rare clinical entity with the undeniable potential for catastrophic repercussions. This case report highlights the first incidence of intraoperative subarachnoid hemorrhage (SAH) in a patient with MB secondary to an intracranial aneurysm.
  
  
  METHODS
  A 6-year-old girl with a left cerebellar mass, fourth ventricle effacement, and triventriculomegally had an external ventricular drain inserted, at which time blood stained cerebral spinal fluid was drained. After insertion of an external ventricular drain, imaging showed diffuse SAH. Post tumor resection scans showed a small residuum of tumor. At repeat tumor resection after chemoradiotherapy, a 2-mm internal carotid aneurysm was noted.
  
  
  CONCLUSIONS
  Intraoperative hemorrhage in MB is a very rare occurrence. We describe the first case of hemorrhage in MB secondary to an intracranial aneurysm. MB has a predisposition to bleed spontaneously that can have catastrophic repercussions. Sudden clinical deterioration after insertion of external ventricular drainage should be susceptive of intracerebral hemorrhage. In cases of uncertain etiology, investigation of SAH with cerebral angiography is recommended.
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Dublin, Ireland; School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland. Electronic address: robert.foley.2@ucdconnect.ie.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Foley
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Dublin, Ireland.
authors.forename: Sam
authors.initials: S
authors.lastname: Ndoro
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Dublin, Ireland.
authors.forename: Darach
authors.initials: D
authors.lastname: Crimmins
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Caird
mesh_terms: D002340:Carotid Artery Diseases / Q000209:etiology / Q000473:pathology; D002528:Cerebellar Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D059248:Chemoradiotherapy; D002648:Child; D004322:Drainage; D017809:Fatal Outcome; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007431:Intraoperative Complications / Q000473:pathology / Q000601:surgery*; D008527:Medulloblastoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000473:pathology / Q000601:surgery*
keywords: Intracranial aneurysm; Medulloblastoma; Subarachnoid hemorrhage