INTRODUCTION:
Primary Intraventricular Hemorrhage (PIVH) refers to bleeding that occurs specifically within the ventricular system of the brain, without any involvement or bleeding within the surrounding brain tissue. It is a rare occurrence comprising approximately 3.1% of non-traumatic central nervous system hemorrhages [1]. While there is some literature on the etiology, clinical features, and management of PIVH in adults, the understanding of this condition in the pediatric population is limited, posing challenges in identifying its characteristics and developing specific management protocols. Available reports suggest that arteriovenous malformations, Moya Moya disease, and aneurysms are among the commonly implicated causes in pediatric cases [2]. Surgery, particularly the use of an External Ventricular Drain (EVD) to alleviate intracranial pressure in case of acute hydrocephalus, remains the primary approach documented in the literature [2]. Due to the significant risks of mortality and neurological impairment associated with primary intraventricular hemorrhage (PIVH), it is imperative to thoroughly report and discuss the key features of this condition in the pediatric population. In this context, we present a rare case of isolated PIVH in the fourth ventricle observed in a 10-year-old boy.