H3 K27-altered diffuse midline glioma presenting as massive cerebellopontine hemorrhage

Tej D. Azad, Anita L. Kalluri, Landon J. Hansen, Adam Ammar, Alan R. Cohen

Research output: Contribution to journalArticlepeer-review


We report the case of a 14-year-old boy who presented with extensive cerebellar and brainstem hemorrhage. Our presumptive diagnosis was a ruptured arteriovenous malformation (AVM), but two cerebral angiograms showed no significant vascular abnormalities. The patient underwent posterior fossa craniotomy and microsurgical evacuation of the hematoma. Pathological analysis of the hemorrhagic tissue made the diagnosis of diffuse midline glioma, H3 K27-altered (WHO grade 4), based on immunohistochemistry. He subsequently developed diffuse craniospinal leptomeningeal disease and progressed rapidly, with respiratory failure followed by severe neurologic decline without further hemorrhage. He was compassionately extubated at the request of the family and died before initiation of adjuvant therapy. This unusual case of a diffuse midline glioma presenting with massive hemorrhage underscores the importance of searching for an underlying etiology of hemorrhage in a child when a vascular lesion cannot be identified.

Original languageEnglish (US)
Pages (from-to)2229-2232
Number of pages4
JournalChild's Nervous System
Issue number8
StatePublished - Aug 2023


  • Case report
  • H3 K27-altered diffuse midline glioma
  • Intracranial hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'H3 K27-altered diffuse midline glioma presenting as massive cerebellopontine hemorrhage'. Together they form a unique fingerprint.

Cite this