Intracranial Cystic Hemangiolymphangioma as a Cause of Hemorrhagic Stroke in Infants

Abstract

Hemorrhagic stroke in infants is a rare neurological emergency associated with high morbidity and mortality, especially when it originates from intracranial vascular tumors. We describe the case of a previously healthy 32-day-old infant who presented with irritability, pallor, vomiting, and altered mental status, followed by seizures. Computed tomography revealed a 25 cc right frontal intraparenchymal hemorrhage with rupture into a cerebral ventricle and signs of intracranial hypertension. The infant underwent emergency floating craniotomy, evacuation of the hematoma, and complete resection of a vascularized cystic lesion.
During surgery, the infant suffered cardiac arrest, which was reversed within five minutes.
The infant's condition deteriorated in the intensive care unit; he presented with generalized hypotonia, diffuse hypoxic-ischemic injury, minimally conscious state, and global neurodevelopmental delay. The histopathological study confirmed an intracranial cystic hemangiolymphangioma. The patient subsequently developed multifocal epilepsy, which was controlled with levetiracetam.
This case highlights the importance of early recognition of hemorrhagic stroke in pediatric emergencies, the consideration of vascular tumors in the differential diagnosis, and the inherent difficulties of neurosurgical management in infants. It also underscores the severity of permanent neurological sequelae following extensive hemorrhages and emphasizes the importance of a continuous and timely multidisciplinary approach.