Spontaneous aneurysmal subarachnoid haemorrhage in a child with multiply recurrent posterior fossa juvenile pilocytic astrocytoma

Description

A 9-year-old boy with a history of posterior fossa juvenile pilocytic astrocytoma presented to the emergency room for lethargy and worsening headache. Three years earlier, he underwent near total resection of the tumour. Owing to the progressive disease, he had a second resection and underwent conformal radiation therapy, totalling 5040 cGy. In the following 2 years, he reported of severe headaches. Multiple brain MRIs with and without contrast and head CTs without contrast did not reveal disease recurrence or significant abnormality. On the day of presentation, the child again reported of a severe headache and was brought to the emergency department (ED). In the ED, he rapidly decompensated. Neurological examination showed a large and non-reactive right pupil. CT of the head revealed a spontaneous fresh haemorrhage in the right cerebellum. CT angiography showed an abnormal tangle of vessels off the right posterior–inferior cerebellar artery (figure 1A–C). Neurosurgical...

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