Abstract
BACKGROUND: Astroblastoma is an extremely rare tumor of the central nervous system, and its origin and validity as a different entity are still being debated. Because of its rarity and similarities to other glial neoplasms, it is often misdiagnosed, impacting treatment and outcomes. OBSERVATIONS: Astroblastoma is very rare and mainly affects children and young adults. It does not have a definitive World Health Organization grade and is divided into low- and high-grade categories. The clinical presentation is consistent with signs of intracranial hypertension. Radiographic imaging shows a bubbly, solid-cystic supratentorial mass with irregular contrast enhancement. The case reported herein is unusual because the intratumoral hemorrhage caused compression and midline shift, requiring urgent surgery. LESSONS: Astroblastoma with intratumoral hemorrhage is atypical and is associated with high-grade tumors. Managing severe intracranial hypertension requires emergency surgery to prevent fatalities. Treatment can include adjunctive chemotherapy and radiation therapy based on the extent of tumor resection. https://thejns.org/doi/10.3171/CASE24486.