Spontaneous hemorrhage in medulloblastomas.

A newborn girl was delivered vaginally by vac uum extraction following fetal cardiac deceleration and a prolonged second stage of labor . The baby had a right-sided cephalohematoma and right facial palsy as well as opisthotonos. Noncontrast CT demonstrated hemorrh age into enlarg ed lateral ventric les and a high-density area in the right cerebellopontine angle sugg esting an intraparenc hymal hematoma (fig. 1 A) . CT 4 days after birth was essentially unchanged, but, because of a dec reasing hematocrit, the ce rebellar hematoma was evacuated. Th e baby continu ed to deteriorate, and , 10 days after birth, CT was repeated. It demonstrated a high-density mass in the right cerebellum , larger than before , which enhanced homogenously after administration of intravenous contrast material. The pati ent remained stable for 3 weeks and then deteriorated furth er. CT 1 month after birth showed an enlarged enhanc ing mass compressing the fourth ventric le (figs. 1 Band 1 C). Surgery demonstrated a right cerebellar hematom a with c lusters of medu lloblastoma ce lls within it as well as adjacent solid areas of medulloblastoma. Th e infant died 4 days after surgery of respiratory arrest resulting from involvement of th e brain stem by tumor.