title: Spontaneous Intraventricular Hemorrhage: A Rare Presentation of a Skull Base Mesenchymal Chondrosarcoma.
abstract: BACKGROUND
  Chondrosarcomas are very rare malignant, slow-growing tumors that develop in or near the petroclival region of the brain. We report a very rare case in which the tumor originated from left petrous bone and induced intraventricular hemorrhage leading to an acute comatose presentation.
  
  
  METHODS
  A 28-year-old man initially presented to the outpatient department with a 1-month history of headache, vomiting, vertigo, and left facial numbness. A lesion at the cerebellopontine angle with extension into the middle cranial fossa was demonstrated on computed tomography and magnetic resonance imaging. The following night his condition worsened, and he presented to the emergency department with intraventricular hemorrhage with hydrocephalus. An external ventricular drain was placed in the emergency department to relieve hydrocephalus, and definitive surgical resection of the tumor was subsequently. Postoperatively, his Glasgow Coma Scale score improved, and he was transferred to the surgical intensive care unit where he remained for 3 days. He was subsequently stepped down to a special care unit and then to a ward room. The patient is currently awake and has grade II facial palsy (House-Brackmann), demonstrates spontaneous purposeful eye opening, inconsistently obeys single-step orders, demonstrates no meaningful phonation or vocalization, and has at least grade 4 power in all 4 extremities. He is currently fed through a nasogastric tube and is in rehabilitation.
  
  
  CONCLUSIONS
  Our experience of petroclival junction chondrosarcoma causing intraventricular hemorrhage may be the first to be documented. Preferred treatment of this highly malignant lesion is radical removal with postoperative radiotherapy.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: altaf.alilaghari@aku.edu.
authors.forename: Altaf Ali
authors.initials: AA
authors.lastname: Laghari
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Gohar
authors.initials: G
authors.lastname: Javed
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad Faheem
authors.initials: MF
authors.lastname: Khan
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed Ijlal
authors.initials: SI
authors.lastname: Ahmed
authors.affiliation: Medical College, Aga Khan University, Karachi, Pakistan.
authors.forename: Karim Rizwan
authors.initials: KR
authors.lastname: Nathani
authors.affiliation: Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Riyasat
authors.initials: R
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D002530:Cerebellopontine Angle / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging*; D018211:Chondrosarcoma, Mesenchymal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000000981:diagnostic imaging; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D010579:Petrous Bone / Q000000981:diagnostic imaging; D019292:Skull Base Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Chondrosarcoma; Intraventricular hemorrhage; Petroclival region