Seizure-Onset Intracerebral Hemorrhage of Undetermined Etiology in a Child: Anesthetic, Intensive Care, and Rehabilitation Management

Hemorrhagic stroke is rare in children but carries a substantial risk of mortality and long-term neurological disability.Its presentation may be nonspecific, with seizures and impaired consciousness potentially mimicking infectious or metabolic disorders.We report the case of an eight-year-old girl with no personal or family history of neurological disease and reportedly normal psychomotor development who presented with seizures, vomiting, and impaired consciousness.The initial computed tomography report described a left parietal intraparenchymal hematoma associated with intraventricular hemorrhage and mass effect.Emergency surgical evacuation was performed under general anesthesia, with intraoperative osmotherapy and invasive hemodynamic monitoring.The postoperative course was characterized by progressive recovery of consciousness, although right hemiplegia and aphasia persisted.Brain magnetic resonance imaging performed on postoperative day three showed an evolving intraparenchymal hematoma without appreciable contrast enhancement.Three-dimensional time-of-flight magnetic resonance angiography demonstrated preserved patency of the major intracranial arteries of the circle of Willis, without an apparent intracranial aneurysm or significant arterial stenosis.However, the available investigations did not establish the cause of the hemorrhage, and cerebral venous thrombosis or an occult vascular lesion could not be excluded.Multidisciplinary rehabilitation was initiated early.At six months, the patient was independent in the main activities of daily living and walked without an assistive device, with residual mild right-sided motor impairment, reduced right-hand dexterity, and mild language difficulties.This case illustrates the importance of rapid multidisciplinary management and continued rehabilitation after pediatric intracerebral hemorrhage, as well as the need for a complete etiological evaluation and appropriate vascular follow-up when the initial investigations are inconclusive.