Intraventricular hemorrhage (IVH) in children is uncommon and it comprises about 3% of spontaneous cerebral hemorrhages. Intraventricular hemorrhage occurs mostly simultaneously with cerebral hemorrhage or subarachnoid hemorrhage. Primary IVH occurs mostly in adults; however, it has been reported since the age of nine. Acute hemorrhage may cause sudden or thunderclap headaches, decreased level of consciousness, and neck stiffness along with focal neurological deficits and convulsions and can be rapidly fatal.

An eight-year-old girl with no history of underlying disease was referred to the Emergency Department of Hazrat Masoumeh Hospital, Qom, Iran, with sudden headache, vomiting, and visual disturbances. There, she had generalized seizures, and after entering the Pediatric Intensive Care Unit, she suffered from irregular breathing and bilateral mydriasis of the pupils without reaction to light.

In the brain computed tomography scan, bilateral IVH and hydrocephalus were seen. Finally, the patient was declared brain-dead and died four weeks later.

Sudden spontaneous IVH in children is rare and creates potentially dangerous and emergency conditions for them. To manage the treatment of these patients, attention should be paid to the three principles of stopping bleeding, controlling hydrocephalus, and treatment of intracerebral pressure. Early treatment prevents severe brain complications and death. For patients with headaches, vomiting, and restlessness, we must consider careful neurological examinations.The purpose of presenting this article was to diagnose and manage emergency treatment in children with cerebral hemorrhage and intracerebral pressure control to prevent neurological complications and death.