Hemorrhage into Craniopharyngioma as a Differential Diagnosis of Pituitary Apoplexy: A Case Report and Literature Review

Abstract

Hemorrhage occurring in craniopharyngioma, with clinical presentation similar to pituitary apoplexy, is a very rare event; with only 20 cases reported. Hyponatremia, hemiplegia and upper motor neuron facial palsy occurring in such a situation is still rarer.

We report the case of a 60-year-old lady who presented with right hemiplegia, diminished vision, right upper motor neuron facial palsy and hyponatremia. Computed tomography showed a hypodense lesion in the sellar and supra-sellar region with hemorrhage extending to left basal ganglia. Magnetic resonance imaging revealed a T2-hyperintense lesion with peripheral contrast enhancement in the sellar and suprasellar regions. The pre-operative diagnosis was pituitary macroadenoma with hemorrhage.

The relatively avascular tumor was excised sub totally by craniotomy. Histopathological examination of the specimen revealed adamantinomatous type of craniopharyngioma. Literature review was based on 17 publications and a total of 20 patients. Their clinical features, locations of the tumor and histological types are tabulated.