Abstract
Pilocytic astrocytomas are histologically benign tumors, generally found in the pediatric population. Onset of symptoms is generally insidious, predominantly stemming from mass effect upon nearby structures. Patients harboring a pilocytic astrocytoma may present with gait disturbance, headaches, cranial nerve deficits, as well as hydrocephalus, depending on the exact location. Although cases of adult pilocytic astrocytomas in the adult population are described, they are quite uncommon. We present a case of an adult female presenting with acute neurological compromise resulting from an acutely hemorrhagic posterior fossa pilocytic astrocytoma. Her initial neurological assessment was consistent with a Glasgow coma scale of 4T, as the patient was experiencing decerebrate posturing. An emergent external ventricular drain was placed in the emergency department for acute hydrocephalus as a temporizing measure, prior to evacuation of the associated subdural and intratumoral hemorrhages, as well as resection of the mass. After a long hospital course and extensive rehabilitation, the patient made a remarkable recovery and eventually gave birth to a child via Caesarean section three years after her initial presentation.
Highlights
Pilocytic astrocytomas are pathologically benign tumors typically seen in the pediatric population
We present a case of an adult female presenting with acute neurological compromise resulting from an acutely hemorrhagic posterior fossa pilocytic astrocytoma
We aim to present an unusual case of an adult harboring a cerebellar pilocytic astrocytoma presenting in an acute fashion with a rapid neurological decline after spontaneous intratumoral hemorrhage
Summary
Pilocytic astrocytomas are pathologically benign tumors typically seen in the pediatric population. Their clinical presentation is rather insidious from the onset and rarely acute. Depending on their location within the brain, and whether they are supratentorial or infratentorial, their symptomatology varies. Patients with supratentorial pilocytic astrocytomas may present with headaches and symptoms of a mass effect upon nearby structures, potentially leading to hydrocephalus or sensorimotor disturbances. Infratentorial pilocytic astrocytomas can be a cause of hydrocephalus but may cause compression of the cranial nerves with subsequent palsies. We aim to present an unusual case of an adult harboring a cerebellar pilocytic astrocytoma presenting in an acute fashion with a rapid neurological decline after spontaneous intratumoral hemorrhage. The vast majority of pilocytic astrocytomas are not associated with hemorrhage, leading one to infer that a small subpopulation of these tumors may have inherent features making them more susceptible to hemorrhagic
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