Sudden-onset nonhemorrhagic Rathke’s cleft cyst mimicking apoplexy: A case report and literature review

Most Rathke’s cleft cysts (RCCs) are asymptomatic. Of the symptomatic RCCs, those that rapidly develop and cause hemorrhagic RCC apoplexy are particularly rare. In this study, we report a case of nonhemorrhagic RCC apoplexy that is an acute-onset RCC without intracystic hemorrhage. This study included a 21-year-old male patient. His chief complaints were severe headache with sudden disturbance of consciousness, visual disturbance, and double vision. Head computed tomography (CT)/magnetic resonance imaging (MRI) and clinical course indicated a hemorrhagic RCC apoplexy that is an acute-onset RCC with intracystic hemorrhage, a nonhemorrhagic RCC apoplexy, or a pituitary apoplexy. We then performed endoscopic transsphenoidal surgery. Histopathological examinations revealed a nonhemorrhagic RCC apoplexy. The preoperative diagnosis makes it difficult to distinguish between acuteonset hemorrhagic RCC apoplexy, nonhemorrhagic RCC apoplexy, and pituitary apoplexy. We compared 26 cases of hemorrhagic RCC apoplexy with cases of nonhemorrhagic RCC apoplexy by reviewing previous literatures. Furthermore, we have determined the characteristics of nonhemorrhagic RCC apoplexy. Knowledge on these characteristics may be useful in the differential diagnosis. For the differential diagnosis and treatment of RCC apoplexy and pituitary apoplexy, it is important to appropriately perform surgical treatment and make an accurate diagnosis based on surgical and pathological findings.