{"id":"cb4bc513-9f01-46c0-9ddc-d16f60c07862","slug":"adolescent-massive-delayed-intratumoral-hemorrhage-in-a-long-standing-pilocytic-astrocytoma-a-case-report","title":"Adolescent massive delayed intratumoral hemorrhage in a long-standing pilocytic astrocytoma: A case report","authors":["Abdulaziz Hamzah","Ziad Alzahrani","Muhammad Adil","Mohammed Homoud"],"abstract":"Background: Pilocytic astrocytoma (PA) is a World Health Organization (WHO) Grade I glioma with generally indolent behavior. Spontaneous intratumoral hemorrhage is uncommon, and massive bleeding years after initial diagnosis is exceedingly rare. Case Description: A 16-year-old male with right thalamic PA underwent subtotal resection and ventriculoperitoneal shunt placement in 2018. Surveillance magnetic resonance imaging through May 2025 showed a stable residual tumor (~7 × 4 × 5 cm). In July 2025, he presented with an acute headache, vomiting, altered consciousness Glasgow coma scale 7 (GCS 7), and left hemiplegia. Computed tomography revealed a ~4.5 × 5 × 4.5 cm intratumoral hemorrhage with intraventricular extension and obstructive hydrocephalus. Emergent external ventricular drain placement, right frontal craniotomy, hematoma evacuation, and biopsy were performed. Histopathology confirmed WHO Grade I PA (Ki-67 <4%, p53 wild-type, isocitrate dehydrogenase 1 (IDH 1)-negative) with no evidence of malignant transformation. No systemic coagulopathy or trauma was identified. The patient improved neurologically and was discharged in stable condition. Conclusion: This case represents a rare delayed hemorrhage in a long-standing PA without malignant transformation. It highlights that even radiologically stable low-grade gliomas may carry a small risk of catastrophic bleeding and shows the importance of long-term follow-up and awareness of this potential complication.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/cb4bc513-9f01-46c0-9ddc-d16f60c07862/featured/hero-1781557849928.png","publishDate":"2026-02-27T00:00:00.000Z","doi":"10.25259/SNI_1062_2025","categories":["Neuro-oncology","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/cb4bc513-9f01-46c0-9ddc-d16f60c07862/pdf"}