Hemorrhagic Rathke's cleft cyst presenting as diplopia

Area of Science:

• Neuroscience
• Endocrinology
• Pathology

Background:

• Rathke's cleft cysts (RCCs) are congenital cysts arising from remnants of the Rathke's pouch.
• While typically located in the pituitary region, RCCs can present with diverse clinical manifestations due to their location and potential for complications like hemorrhage.

Purpose of the Study:

• To report a rare case of a hemorrhagic Rathke's cleft cyst (RCC) with unusual extension into the cavernous sinus.
• To describe the clinical, radiologic, and histologic findings of this specific presentation.
• To review the literature on challenging RCC presentations.

Main Methods:

• Case presentation of a 34-year-old male with headache and diplopia.
• Magnetic resonance imaging (MRI) for pituitary mass evaluation.
• Hormonal level assessment.
• Transsphenoidal resection and histopathological examination of the cyst.
• Literature review of related medical cases.

Main Results:

• The patient presented with headache and acute onset of diplopia due to a pituitary mass extending into the cavernous sinus.
• MRI revealed a left pituitary mass involving the cavernous sinus.
• Hormonal evaluation showed hypothyroidism and hyperprolactinemia.
• Histopathology confirmed a hemorrhagic RCC.
• Post-operative complications included transient diabetes insipidus, requiring levothyroxine therapy.

Conclusions:

• Hemorrhagic RCCs can present with atypical symptoms, including ophthalmoplegia due to cavernous sinus extension.
• Diagnostic imaging and clinical presentation of RCCs can be heterogeneous.
• Early diagnosis and appropriate management are crucial for improving patient outcomes, despite diagnostic challenges.