Intracranial hemorrhage from an aneurysm encased in a pilocytic astrocytoma - case report and review of the literature

The authors present an unusual complication of a recurrent chiasmal/hypotha lamic pilocytic astrocytoma. From his second year of lifeonwards, the patie nt was repeatedly operated on and also underwent external radiation therapy (54 Gy total dose) 1 month after the first sub-total tumor resection. Nine years after irradiation, the patient was referred to our center with a sud den onset of severe headache, vomiting and neck stiffness. Computed tomogra phy, magnetic resonance imaging, and cerebral angiography demonstrated an i ntratumoral, intraventricular, and subarachnoidal hemorrhage from an anteri or communicating artery aneurysm encased in the pilocytic astrocytoma. The aneurysm was clipped and the patient recovered nicely from the hemorrhage. Three years later, the patient suddenly died of cardiac failure. Autopsy di sclosed vessel wall changes compatible with radiation-induced vasculopathy. In light of this finding, the importance of radiation therapy and intracra nial neoplasms for aneurysm formation is discussed.