颅咽管瘤表现为类似中风的一例报告

Zachary Boivin , Chandler Ford , Andrew Franco
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引用次数: 0

摘要

颅咽管瘤是一种罕见的疾病,可表现为颅内压升高、内分泌紊乱、视力缺陷和下丘脑功能障碍等多种症状,使其难以诊断。在这个病例中,我们的病人表现出中风的症状,造成了诊断的不确定性。病例报告一名71岁男性在数小时内出现右手握力下降和语言发现困难,到达急诊室后被分类为潜在的中风。初步影像显示他在蝶鞍区出血。随后,多学科输入导致颅咽管瘤的初步诊断。患者的实验室结果引起了对肾上腺功能不全的关注,患者的心动过缓、低血压和体温过低的生命体征异常在皮质类固醇治疗后得到了缓解。患者在短暂住院后出院,神经外科建议门诊随访切除肿块。急诊医生为什么要意识到这一点呢?我们没有发现任何文献将颅咽管瘤描述为中风的模拟,并且考虑到患者最初的表现为右手无力和言语识别困难,因此高度关注中风。患者的影像学显示似乎是颅内出血,进一步混淆了临床表现。患者随后发展的生命体征和与肾上腺危机一致的实验室结果帮助我们得出最终诊断。急诊医生在治疗卒中样症状患者时应避免锚定偏差,并熟悉颅咽管瘤的复杂表现。
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Craniopharyngioma presenting as a stroke mimic, a case report

Background

Craniopharyngioma is a rare condition which can present with a multitude of symptoms from increased intracranial pressure, endocrine disorder, visual deficits, and hypothalamic dysfunction, making it difficult to diagnose. In this case, our patient presented with symptoms concerning for a stroke, creating diagnostic uncertainty.

Case report

A 71-year-old male developed decreased grip strength in his right hand and word finding difficulties over a period of several hours, and upon arrival to the emergency department was triaged as a potential stroke. On initial imaging he appeared to have a hemorrhage in the area of the sella turcica. Subsequently, multidisciplinary input resulted in a preliminary diagnosis of craniopharyngioma. The patient's laboratory results raised concern for adrenal insufficiency, and the patient's vital sign abnormalities of bradycardia, hypotension, and hypothermia resolved with corticosteroids. The patient was discharged home after a brief hospital stay, and neurosurgery recommended outpatient follow up to excise the mass.

Why should an emergency physician be aware of this

We could find no literature describing craniopharyngioma as a stroke mimic, and given the patient's initial presentation with right hand weakness and word finding difficulty, there was high concern for stroke. The patient's imaging showed what appeared to be an intracranial hemorrhage, further confounding the clinical picture. The patient's subsequent development of vital signs and laboratory results consistent with adrenal crisis helped us arrive at the final diagnosis. Emergency physicians should avoid anchoring bias in the treatment of patients with stroke-like symptoms and be familiar with the complex presentations of craniopharyngioma.

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来源期刊
JEM reports
JEM reports Emergency Medicine
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审稿时长
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