Rathke cleft cyst presenting as unilateral progressive oculomotor nerve palsy

Yum, Hae Ri; Jang, Jinhee; Shin, Sun Young; Park, Shin Hae

doi:10.1016/j.jcjo.2014.11.017

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…[1,4,5,7,9] Some cranial nerves palsy has been reported in association to RCC but they are extremely rare. [11] Also selective gland incision seems to lower the endocrine impact of neurosurgery. [12] The risk of recurrence is higher in a suprasellar cyst location and size of the tumor, the finding of squamous metaplasia at pathological report of the cyst wall, and isointense features on T2weighted MRI while the extent and type of surgery approach are not at risk of recurrence based on some observations and others reported a higher risk in case of incomplete resection, intra-operative leak of cerebrospinal fluid, and in cases when an abdominal fat graft or sellar packing was necessary.…”

Section: Discussionmentioning

confidence: 99%

From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

Valea

Marcusan²,

Cârșote

et al. 2015

ARS Medica Tomitana

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Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism. Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary. Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding

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Section: Discussionmentioning

confidence: 99%

From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

Valea

Marcusan²,

Cârșote

et al. 2015

ARS Medica Tomitana

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“…This is the same structure from which craniopharyngiomas arise. RC can be associated with pituitary dysfunction (including panhypopituitarism) and has been reported to cause apoplexy, oculomotor palsy, and adrenal crises 2–5 ;however, this is the first report to show where RC has been associated with an isolated Adrenocorticotropic hormone (ACTH) deficiency. Given this unusual presentation, our case was initially thought to be of Addison's disease because of the low serum cortisol, then Syndrome of Inappropriate Anti‐Diuretic Hormone Secretion (SIADH) because of hyponatremia until a repeat MRI brain showed typical findings of RC.…”

Section: Introductionmentioning

confidence: 97%

A rare case of isolated ACTH deficiency associated with a Rathke's Cleft Cyst and a review of the literature

Azam,

Tuch

2023

Clinical Case Reports

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Key Clinical MessageA 78‐year‐old man was referred to clinic due to a 5‐year history of weight loss, lethargy, and pathology showing hyponatremia. In the year prior, he had a hospital admission for symptomatic hyponatremia. MRI brain during that admission showed a 1–2 mm pituitary lesion of unknown significance. Testing during this presentation revealed hypocortisolism with ACTH deficiency. Progress MRI brain revealed the presence of a Rathke's Cleft Cyst (RC). Medical management with glucocorticoids resulted in symptomatic and biochemical parameter improvement. To our knowledge this is the first reported case of isolated ACTH deficiency in the setting of a RC.

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“…Commonly, varying degrees of headache, nausea, impaired consciousness, and neuropathies of the 4th and 6th cranial nerves are simultaneously present in these patients [2], [3], [4]. In contrast, pituitary tumor presenting with CN III paresis as the sole symptom has rarely been documented [5]. In CN III paresis manifested by pituitary adenomas, early treatment, pupil-sparing, and minor oculomotor symptoms are considered as the indicators of good recovery [6].…”

Section: Introductionmentioning

confidence: 99%

Intermittent oculomotor nerve paresis and hollow appearance on MRI manifested by pituitary adenoma

Ikemura

Tsutsumi

Nonaka

et al. 2019

Radiology Case Reports

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A 71-year-old man had sustained intermittent ptosis and double vision for 2 weeks. Neurological examination found unilateral oculomotor nerve (CN III) paresis manifesting as limitations of gaze, ptosis, and mydriasis. Neither headache nor any other cranial neuropathy was noted. Cerebral magnetic resonance imaging revealed a well-circumscribed mass in the pituitary fossa extending laterally into the left cavernous sinus. The segment of the left CN III lying in the oculomotor cistern was considerably compressed by the tumor. The cisternal segments of the left CN III showed an undescribed, “hollow” appearance. The left orbit and brainstem were intact. The patient underwent tumor resection via an endoscopic transsphenoidal approach. The tumor tissue was soft in consistency, involving xanthochromic fluid. The pathological diagnosis was pituitary adenoma accompanied with considerable hemorrhagic changes. The patent's ptosis and limitations of gaze showed remarkable improvements on postoperative day 1, with resolution of the hollow appearance of the affected CN III that was confirmed on day 3. We assumed that the intralesional bleeds and lateral tumor extension into the oculomotor cistern were associated with the intermittent paresis of the CN III as the sole presentation. A hollow appearance identified in the CN III might indicate a reversible dysfunction of the nerve that can anticipate an improvement by prompt surgical intervention.

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Rathke cleft cyst presenting as unilateral progressive oculomotor nerve palsy

Cited by 5 publications

References 14 publications

From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

A rare case of isolated ACTH deficiency associated with a Rathke's Cleft Cyst and a review of the literature

Intermittent oculomotor nerve paresis and hollow appearance on MRI manifested by pituitary adenoma

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