Spontaneous leaking craniopharyngioma causing preoperative chemical meningitis

Unusual circumstance for craniopharyngioma discovery on meningoencephalitis: a pediatric case report

BACKGROUND

Craniopharyngioma is a rare condition in children, but it is the most frequent tumor that occurs in the hypothalamic pituitary region. Chemical meningitis has been described as an uncommon postoperative complication, but no chemical meningitis due to a spontaneous rupture leading to craniopharyngioma diagnosis in children has been reported.

CASE PRESENTATION

This is a case of a 13-year-old boy presenting with fever, vomiting and headache for two days. The CT scan revealed a suprasellar lesion, and lumbar puncture showed aseptic meningitis. The cerebral MRI suggested a craniopharyngioma and the cerebrospinal fluid cholesterol concentration was abnormally high. A thorough medical history indicated some visual disturbance, which improved at the onset of meningitis, and an inflection of the growth curve. The anatomopathological analysis of the tumor confirmed the diagnosis of craniopharyngioma.

CONCLUSIONS

This case is the first to report the discovery of a craniopharyngioma with meningoencephalitis caused by the rupture of a craniopharyngioma cyst in a child. Diagnosis was facilitated by determining the cholesterol level in the cerebrospinal fluid, as well as fine anamnesis to identify visual and growth disturbances.

Aseptic Meningitis Due to Spontaneous Rupture of a Multicystic Craniopharyngioma with an Ommaya Catheter: A Case Report

Craniopharyngiomas (CPs) are benign tumors that are believed to arise from embryonic remnants of the Rathke pouch epithelium. Herein, we report a case of aseptic meningitis due to spontaneous rupture of multicystic CP, which contained an Ommaya catheter. A 19-year-old boy was admitted to the hospital with a 4-day history of acute severe headache after strenuous physical exercise followed by altered sensorium, fever, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed marked pleocytosis and elevated protein levels. CSF culture was otherwise negative. Cyst reduction on subsequent imaging confirmed the diagnosis. The patient received intravenous steroid therapy and was discharged asymptomatic. This is a rare evolution of a multicystic CP, which was previously treated with intracystic therapy and had an Ommaya catheter. Clinicians should be aware of spontaneous CP rupture and look actively for the occurrence of cholesterol crystals or elevated CSF levels of cholesterol as well as prompt follow-up imaging.

Adipsic diabetes insipidus secondary to craniopharyngioma resection

Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.

Chemical meningitis from a leaking craniopharyngioma: a case report

Recurrent chemical meningitis from cyclic leakage of cyst content from a craniopharyngioma is a rare phenomenon. Here, we report a case of leaking cystic craniopharyngioma presenting with recurrent episodes of sterile meningitis, depression, and paranoia. The diagnosis after an initial craniotomy and exploration was hypophysitis. Signs and symptoms were not alleviated by puncture and biopsy of the tumour but they disappeared after complete resection with a final histological diagnosis of craniopharyngioma.

Spontaneous Intra-Parenchymal Rupture of Craniopharyngioma - A Rare Phenomenon

Craniopharyngioma is a relatively benign intracranial tumour that involves sellar and supra-sellar regions. Spontaneous rupture of craniopharyngioma into the sub-arachnoid space or into the ventricles is a rare phenomenon and few cases are reported in literature. We hereby report a case of sellar-suprasellar craniopharyngioma with focal intra-parenchymal rupture into brain causing aggravation of headache in a 12-year-old female child. This complication is a relatively rare phenomenon, which requires attention for early intervention. This was managed by trans-nasal endoscopic trans-sphenoidal surgery. Usually rupture of craniopharyngioma causes chemical meningitis or it can be asymptomatic. Sometimes rupture can cause complete resolution of cyst and symptoms. In the present case, there was only focal rupture and it was into brain parenchyma causing brain oedema with aggravation of headache. Magnetic Resonance Imaging (MRI) in intra-parenchymal rupture of craniopharyngioma has been emphasized in this case report.