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[A case of intracerebellar hemorrhage in infancy]
Insights
Nontraumatic cerebellar hemorrhage in children, though rare, can be successfully treated with surgery. Prompt surgical intervention for cerebellar arteriovenous malformations can lead to significant recovery, even from severe neurological deficits.
Area of Science:
- Pediatric Neurosurgery
- Neurology
Background:
- Nontraumatic intracerebellar hemorrhage is an uncommon pediatric condition.
- Arteriovenous malformations (AVMs) are a rare cause of such hemorrhages in children.
Observation:
- A 6-year-old boy presented with sudden headache, progressing to deep coma and respiratory arrest.
- Computed tomography revealed a cerebellar hemisphere hematoma.
- Emergency suboccipital craniectomy was performed, leading to immediate restoration of respiration.
Findings:
- Vertebral arteriography identified a small arteriovenous malformation supplied by the anterior inferior cerebellar artery.
- Surgical removal of the AVM resulted in an uneventful postoperative course.
- The patient achieved a satisfactory recovery, attending primary school with only slight ataxia.
Implications:
- This case highlights the importance of considering surgical intervention for pediatric nontraumatic intracerebellar hemorrhage, even with severe initial deficits.
- Early diagnosis and surgical management of cerebellar AVMs can lead to significant neurological recovery in children.
- Aggressive surgical treatment for ruptured AVMs in the cerebellum can prevent long-term disability.
Abstract:
Nontraumatic intracerebellar hemorrhage is rare during childhood. We report such a case due to rupture of arteriovenous malformation, in which surgery was able to bring about satisfactory recovery from deep coma without spontaneous respiration. This case shows that operative treatment should not be abandoned even though neurological deficits are very serious. This 6-year-old boy suddenly complained of headache while playing in a nursery and became restless. Because of deterioration of consciousness level followed by loss of respiration, he was transferred from a local physician to our clinic 4 hours after the onset. Computerized tomography scan disclosed a hematoma in the cerebellar hemisphere. Emergency suboccipital craniectomy was carried out 1 hour later. Immediately after operation, respiration was restored. Vertebral arteriography was performed 1 month after the operation, when the patient had recovered but could barely communicate with his family. The study revealed a small arteriovenous malformation supplied by the anterior inferior cerebellar artery. The malformation was removed 3 months after admission. The postoperative course was uneventful and the patient attended a primary school without neurological deficits except for slight ataxia 6 months after the onset.