gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Spontaneous intramedullary hemorrhage of a small brainstem hemangioblastoma in a patient with von Hippel-Lindau disease

Spontane intramedulläre Blutung eines kleinen Hirnstammhämangioblastoms bei einem Patienten mit von-Hippel-Lindau-Syndrom

Meeting Abstract

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  • corresponding author Y. Ryang - Neurochirurgische Klinik, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule Aachen
  • M.F. Oertel - Neurochirurgische Klinik, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule Aachen
  • J.M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule Aachen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.139

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Ryang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Spontaneous hemorrhages in hemangioblastomas are rare. Most bleedings are located in the subarachnoid space. The rare intraparenchymal bleedings are found supratentorially, infratentorially or in the spinal cord. We report an extremely rare case of a brainstem hemorrhage due to a small hemangioblastoma of the medulla oblongata.

Methods: A 47-year-old patient suffered from acute onset of headache, anarthria, inability to swallow, left-sided hemiparesis and hemidysesthesia with changing states of vigilance finally developing acute respiratory failure. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed a small 4 mm hemangioblastoma in the posterior medulla oblongata causing an intraparenchymal hemorrhage and acute triventricular hydrocephalus due to intraventricular hematoma extension.

The acute hydrocephalus was treated by an external ventricular drainage. The intramedullary hemorrhage as well as the hemangioblastoma were removed microsurgically through a posterior median suboccipital approach with minimal foramen magnum enlargement.

Results: Six months after surgery the patient showed good recovery with only slight neurological deficits. He could breathe normally without assistance and spoke with a slightly guttural voice. His difficulty in swallowing was confined to very solid food. He had a minor residual hemiparesis and hemidysesthesia, and was able to ambulate freely and to carry out daily household chores without or with minimal support.

Conclusions: Besides spontaneous intramedullary bleedings usually caused by arterial hypertension or cavernous angiomas, hemangioblastomas should well be taken into consideration as another possible cause of a spontaneous intraparenchymal brainstem hemorrhage. Especially in hemangioblastomas the surgical management strategy is crucial for a successfull result. Therefore the search for a hemangioblastoma should be included into the diagnostic work up in patients with brainstem bleedings.