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Subarachnoid hemorrhage from brain tumors in childhood
Insights
Subarachnoid hemorrhage in children can signal a brain tumor, particularly in the posterior fossa. Early CT scans aid management, but prognosis remains poor due to frequent malignancy.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
- Pediatric Oncology
Background:
- Subarachnoid hemorrhage (SAH) in children is often associated with brain tumors.
- This presentation accounts for 3.6% of pediatric brain tumors and mimics aneurysmal rupture frequency.
Observation:
- Hemorrhage from pediatric brain tumors predominantly occurs in the posterior fossa.
- Medulloblastomas are a common, previously underestimated source of tumor-related hemorrhage.
- Computed Tomography (CT) scans enable early detection of hemorrhagic strokes from brain tumors.
Findings:
- Hemorrhagic stroke from brain tumors is a significant cause of SAH in pediatric patients.
- Early recognition allows prompt management of increased intracranial pressure and brainstem dysfunction.
Implications:
- Despite favorable initial recovery, the long-term prognosis for pediatric patients with hemorrhagic brain tumors is often poor due to tumor malignancy.
- The incidence of hemorrhagic brain tumors in children is higher than previously recognized, emphasizing the need for diagnostic vigilance.
Abstract:
Six children are reported in whom subarachnoid hemorrhage was an initial symptom of brain tumor. In our neurosurgical clinics, this represented 3.6% of pediatric brain tumors and showed a frequency equal to aneurysmal rupture among nontraumatic subarachnoid hemorrhage of children. In pediatric patients, hemorrhages from brain tumors occur predominantly in the posterior fossa. The medulloblastoma, which had been believed to bleed rarely, is now realized to be a common source of tumor hemorrhages in such cases. The introduction of CT scan facilitates early recognition of hemorrhagic stroke from brain tumors and prompt management for acute intracranial hypertension and brainstem dysfunction. Although the patients achieve favorable recovery from their initial catastrophic condition, the ultimate prognosis, in the majority of cases, is still rather poor because such hemorrhages usually develop from a malignant tumor. The present and other recent reports indicate that the incidence of hemorrhagic stroke from brain tumors in pediatric patients is much higher than has been thought and is an important cause of subarachnoid hemorrhage in this age group.