scholarly journals Prolonged Postoperative Pyrexia and Transient Nonnephrogenic Vasopressin-Analogue-Resistant Polyuria following Endoscopic Transsphenoidal Resection of an Infundibular Epidermoid Cyst

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yuichiro Yoneoka ◽  
Yasuhiro Seki ◽  
Katsuhiko Akiyama ◽  
Yuki Sakurai ◽  
Nobumasa Ohara ◽  
...  
Keyword(s):  
Epidermoid Cyst ◽  
Hormone Replacement ◽  
Posterior Lobe ◽  
Endoscopic Transsphenoidal Surgery ◽  
Neurological Sequelae ◽  
Intravenous Antibiotics ◽  
Suprasellar Tumor ◽  
Mollaret's Meningitis ◽  
Intracranial Epidermoid ◽  
Transsphenoidal Resection

Prolonged postoperative pyrexia (PPP) due to Mollaret’s meningitis following endoscopic transsphenoidal surgery (eTSS) for an intracranial epidermoid cyst can be confused with postoperative meningeal infection after transsphenoidal resection, especially in the middle of the COVID-19 pandemic. Anosmia, as well as dysgeusia, cannot be evaluated in patients of eTSS for a while after surgery. We report a case of an infundibular epidermoid cyst with post-eTSS Mollaret’s meningitis (MM). The post-eTSS MM caused vasopressin-analogue-resistant polyuria (VARP) in synchronization with PPP. A 59-year-old man experiencing recurrent headaches and irregular bitemporal hemianopsia over three months was diagnosed with a suprasellar tumor. The suprasellar tumor was an infundibular cyst from the infundibular recess to the posterior lobe of the pituitary, which was gross-totally resected including the neurohypophysis via an extended eTSS. Since awakening from general anesthesia after the gross total resection (GTR) of the tumor, the patient continuously had suffered from headache until the 13th postoperative day (POD13). The patient took analgesics once a day before the surgery and three times a day after the surgery until POD11. Pyrexia (37.5–39.5 degree Celsius) in synchronization with nonnephrogenic VARP remitted on POD18. Intravenous antibiotics had little effect on changes of pyrexia. Serum procalcitonin values (reference range <0.5 ng/mL) are 0.07 ng/mL on POD12 and 0.06 ng/mL on POD18. His polyuria came to react with sublingual desmopressin after alleviation of pyrexia. He left the hospital under hormone replacement therapy without newly added neurological sequelae other than hypopituitarism. After GTR of an infundibular epidermoid cyst, based on values of serum procalcitonin, post-eTSS MM can be distinguished from infection and can be treated with symptomatic treatments. The postoperative transient nonnephrogenic VARP that differs from usual central diabetes insipidus can react with sublingual desmopressin after alleviation of PPP in the clinical course of post-eTSS MM. An infundibular epidermoid cyst should be sufficiently resected in one sitting to minimize comorbidities, its recurrence, or postoperative MM to the utmost.

Malignant Change in an Intracranial Epidermoid Cyst

1981 ◽  
Vol 5 (3) ◽  
pp. 433-435 ◽  
Author(s):  
Philip J. Dubois ◽  
Michael Sage ◽  
J. Scott Luther ◽  
Peter C. Burger ◽  
E. Ralph Heinz ◽  
...  
Keyword(s):  
Epidermoid Cyst ◽  
Malignant Change ◽  
Intracranial Epidermoid

First report of intracranial epidermoid cyst infection and brain abscess caused by Salmonella Paratyphi A

2019 ◽  
Vol 21 (2) ◽  
pp. 85
Author(s):  
Kavita Raja ◽  
DinoopKorol Ponnambath ◽  
PatelBiren Khimji ◽  
JyothiEmbekkat Kaviyil ◽  
GeorgeC Vilanilam ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Epidermoid Cyst ◽  
First Report ◽  
Cyst Infection ◽  
Intracranial Epidermoid

scholarly journals Proton beam therapy for malignant transformation of intracranial epidermoid cyst

2019 ◽  
Vol 12 (7) ◽  
pp. e229388
Author(s):  
Zhe Chen ◽  
Masayuki Araya ◽  
Hiroshi Onishi
Keyword(s):  
Proton Beam ◽  
Malignant Transformation ◽  
Epidermoid Cyst ◽  
Clinical Case ◽  
Proton Beam Therapy ◽  
Facial Paresis ◽  
Surgical Interventions ◽  
Radiation Induced ◽  
Intracranial Epidermoid

We report the first clinical case on the successful use of proton beam therapy in the management of malignant transformation of intracranial epidermoid cyst. A 43-year-old man was initially diagnosed as this disease with left facial paresis, hypesthesia and hypoalgesia in the territories of the trigeminal nerve. After failure of surgical interventions, he was referred to our radiation centre. We performed a postoperative proton beam therapy for treatment. We delivered a total dose of 57 GyE in 31 fractions. He tolerated the treatment well with mild acute toxicities and remained healthy and functional by 2-year follow-up postradiotherapy. No evidence of delayed radiation-induced neurotoxicity was observed.

Intracranial Epidermoid Cyst in a Horse

2003 ◽  
Vol 129 (1) ◽  
pp. 89-92 ◽  
Author(s):  
M. Peters ◽  
K. Brandt ◽  
P. Wohlsein
Keyword(s):  
Epidermoid Cyst ◽  
Intracranial Epidermoid

scholarly journals Intracranial Epidermoid Cyst Including Elements of Old Hematoma —Case Report—

1997 ◽  
Vol 37 (11) ◽  
pp. 861-864 ◽  
Author(s):  
Hideo TSURUSHIMA ◽  
Takao KAMEZAKI ◽  
Yuji TOMONO ◽  
Tadao NOSE
Keyword(s):  
Case Report ◽  
Epidermoid Cyst ◽  
Intracranial Epidermoid

scholarly journals SAT-244 Inflammatory Rathke Cleft Cyst Caused Hypothalamic Panhypopituitarism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tangiku Mariko ◽  
Tatsuo Ishizuka ◽  
Kei Fujioka ◽  
Saori Inui ◽  
Hideki Tani ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
High Intensity ◽  
Rare Case ◽  
Hormone Replacement ◽  
Ct Scanning ◽  
Serum Cortisol ◽  
Pituitary Hormones ◽  
Posterior Lobe ◽  
Lh Rh ◽  
T2 Weighted Images

Abstract Background: Hypothalamic panhypopituitarism was a rare disease which was caused by brain tumors such as Rathke cyst, germinoma, malignant lymphoma and craniopharyngioma, and vascular accidents such as thrombosis and hemorrhage. We have found a rare case of hypothalamic panhypopituitarism occurred by the inflammation of Rathke cyst. Case presentation: A 77-year-old woman was admitted to our hospital because of severe headache, nausea, vomiting and fever. Hyponatremia (Na 131 meq/L) and increased CRP level (0.20 mg/dl) and no finding of gastroenterological examination and abdominal CT scanning were observed. Endocrinological examination revealed low levels of anterior pituitary hormones such as GH, LH, FSH and ACTH and increased PRL levels and low level of serum cortisol. Simultaneous CRH, TRH and LH-RH stimulations tests indicated low responses of TSH, LH, FSH and PRL and hyperesponse of ACTH (from 2.4 to 251 pg/ml). Radiological examination by enhanced MRI revealed high intensity of T2-weighted images and low and partial high intensities of T1-weighted images in swelling of pituitary gland and vanishment of high intensity of posterior lobe in T2-weighted images suggesting that the inflammatory wall of Rathke cyst. We searched previous data of ACTH and cortisol levels which showed normal level of ACTH (55.2 pg/ml) and cortisol 18.8 μ;g/dl) when headache and nausea arouse on 50 days before. Based on above results patient was diagnosed as hypothalamic hypopituitarism due to inflammatory Rathke cyst. Therefore, patient was treated with hormone replacement therapy by 20 mg of hydrocortisone. After these treatment, polyuria, urinary low osmotic pressure and hypernatremia appeared due to partial diabetes insipidus caused by the impairment of posterior lobe in pituitary gland, and diagnosed by the examination of vasopressin test. This patient was also treated by the oral desmopressin acetate hydrate (60 μ;g/day), and has been well-tolerated in the outpatient clinic. Conclusion: These results suggested that inflammatory Rathke cyst with inflammatory changes in hypothlamo-pituitary system raised a rare case of hypothalamic panhypopituitarism.Reference: Nishioka H. et al.: Clin Endocrinology (Oxf) 2006:64:184–188

scholarly journals Recurrent aseptic mollaret’s meningitis

2021 ◽  
Author(s):  
Débhora Geny de Sousa Costa ◽  
Tércio Luz Barbosa ◽  
Maria Arlete da Silva Rodrigues ◽  
Larissa Alves dos Santos Silva ◽  
Sharlla Layana Leite Mendes ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Cranial Nerves ◽  
Etiologic Agent ◽  
Social Impairment ◽  
Motor Deficits ◽  
Neck Stiffness ◽  
Stiff Neck ◽  
Neurological Sequelae ◽  
Mollaret's Meningitis

Context: Mollaret’s meningitis is a rare disease, where there are recurrent episodes of aseptic meningitis, characterized by fever, headache, meningitis, and cerebrospinal fluid pleocytosis with Mollaret cells, and without neurological sequelae. It is characterized by episodes of illness and episodes of remission, with no detectable etiologic agent. Case report: 38-year-old man, previously healthy, with repeated cases of severe holocranial headache, associated with nausea and vomiting, without fever and with neck pain and stiff neck. The condition was repeated 9 times during the period of 1 and a half years. In the neurological examination (during the symptoms), he presented normal fundus examination, neck stiffness present, without other meningeal signs and focal motor deficits or associated cranial nerves. Extensive serum investigation (including serology, autoimmune markers, and sputum BK test) was performed, all negative. Skull CT and MRI of the skull and cervical spine with contrast during events without abnormalities. Lumbar punctures performed during this period did not show an increase in intracranial pressure on spinal manometry; CSF analyzes showed a clear and colorless appearance, pleocytosis (higher cell count 255 cells), lymphomononuclear predominance, hyperproteinorrhachia(higher value of 100 mg/dl), with normal glucose and lactate. In the CSF samples, extensive etiological investigation (broad viral panel, general bacteria search, syphilis and Mycobacterium tuberculosis, fungi and neoplastic cells) was carried out, all negative. Cisternoscintigraphy performed excluding cerebrospinal fluid fistulas. The patient evolved without neurological sequelae. Conclusions: Mollaret’s recurrent aseptic meningitis is associated with social impairment and functional limitations. Thus, further discussions on conduct and prognosis are needed.

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