Acute Neurological Deterioration in an Adult with a Cerebellar Pilocytic Astrocytoma Accompanied by Intratumoral Hemorrhage, Subdural Hematoma, and Obstructive Hydrocephalus

摘要

Acute neurological deterioration from intratumoral hemorrhage within a cerebellar pilocytic astrocytoma in an adult is an extremely rare presentation of this otherwise benign, predominantly pediatric tumor. Cerebellar pilocytic astrocytomas may present with cranial nerve deficits, headaches, dysmetria, and gait disturbances, as well as symptoms of hydrocephalus, including headaches nausea, and emesis [1]. Symptoms typically progress in a more insidious fashion over time, as it is quite uncommon for pilocytic astrocytomas to present in such an acute manner, as did the subject of our case. Our patient presented with a Glascow coma scale of 4T, and was found to have a large right-sided cerebellar hemorrhagic mass?with an associated posterior fossa subdural hematoma, effacement of the fourth ventricle, and hydrocephalus. An emergent external ventricular drain was placed as a temporizing measure prior to urgently performing a suboccipital craniotomy and tumor resection. The patient had an excellent outcome after a long hospital course, and gave birth to her first child via Cesarean section three years after the inciting event.