Rupture of hemangioblastoma in the posterior part of the fourth ventricle is manifested as a ventricular system hemorrhage: a case report and literature review

The rupture of hemangioblastoma with a hemorrhage, especially a ventricular system hemorrhage caused by the rupture of a hemangioblastoma located in the posterior part of the fourth ventricle, is very rare. This study reports a case of this rare disease. The patient was a 38-year-old male with onset after a sudden headache. Computed tomography examination after onset revealed a hemorrhage in the fourth ventricle, third ventricle, and lateral ventricles that resembled a simple intraventricular hemorrhage. Further imaging via computed tomographic angiography (CTA) and digital subtraction angiography (DSA) indicated that the blood supply for the tumor was from the posterior inferior cerebellar artery. The CTA and DSA examinations clarified that the hemorrhage in the fourth ventricle was caused by a lesion in the posterior part of the fourth ventricle instead of a simple intraventricular hemorrhage. Surgical treatment was provided. The lesion located at the inferior medullary velum and the median aperture of the fourth ventricle was intraoperatively observed to have a blood supply from the distal branch of the posterior inferior cerebellar artery. The lesion was fully resected and was postoperatively confirmed by pathology to be a hemangioblastoma. Therefore, the rupture of an infratentorial hemangioblastoma might also occur under extremely rare conditions. When the tumor is located in the posterior part of the fourth ventricle, the hemorrhage can enter the fourth ventricle and cause ventricular system hemorrhage. The hemorrhage might cover the tumor, and the condition may then manifest as a simple intraventricular hemorrhage such that the diagnosis would be easily missed, resulting in misdiagnosis.