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Case Reports
. 2023 Sep 12;17(1):388.
doi: 10.1186/s13256-023-04115-5.

Rathke's cleft cyst discovered with ruptured anterior communicating artery aneurysm: a case report

Nipun Lakshitha de Silva  1   2 , Hemantha Gunathilaka  3 , Saman Wadanamby  3 , Manilka Sumanatilleke  4 , Noel Somasundaram  4
Affiliations
Case Reports

Rathke's cleft cyst discovered with ruptured anterior communicating artery aneurysm: a case report

Nipun Lakshitha de Silva et al. J Med Case Rep. .

Abstract

Introduction: Rathke's cleft cysts are thought to have a benign clinical outcome apart from associated hypopituitarism and visual defects. Synchronous central nervous system lesions, including pituitary adenoma and intracerebral aneurysms, are rarely reported. Diagnosis of Rathke's cleft cyst after presenting with a subarachnoid hemorrhage due to a ruptured arterial aneurysm is reported only once before.

Case presentation: A 33-year-old Sri Lankan female presented with a subarachnoid hemorrhage due to a ruptured anterior communication artery aneurysm. She underwent pterional craniotomy and aneurysm clipping. She was found to have partial cranial diabetes insipidus and hypogonadotropic hypogonadism. She had a cystic lesion occupying enlarged sella turcica with characteristics of a Rathke's cleft cyst. Subsequently, she underwent trans-sphenoidal excision of the sellar lesion. Histology confirmed the diagnosis of Rathke's cleft cyst.

Conclusions: Rare co-occurrence of a Rathke's cleft cyst and an anterior communicating artery aneurysm would have been missed if subtle manifestations atypical for subarachnoid hemorrhage were not further pursued. This could have led to progressive visual deterioration and hypopituitarism.

Keywords: Anterior communicating artery aneurysm; Rathke’s cleft cyst; Subarachnoid hemorrhage.

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Conflict of interest statement

All the authors declare that there is no conflict of interest regarding the publication of this manuscript.

Figures

Fig. 1
Fig. 1
Non-contrast computed tomography of the head performed on initial presentation showing high-density signals in the basal cisterns suggestive of acute subarachnoid hemorrhage (B, C, red arrow). There is a nonspecific hypodensity in the sellar region (A, red asterisk). Cerebral digital subtraction angiogram performed during the initial presentation shows a bi-lobed secular aneurysm of the anterior communicating artery with the aneurysm sac measuring 3.7 × 4 mm anteriorly and laterally (D, white arrow)
Fig. 2
Fig. 2
Coronal (A) and sagittal (B) T1 post-contrast and T2 sagittal (C) sections of the magnetic resonance imaging of the pituitary region showing 1.5 cm × 1.7 cm × 1.7 cm cystic mass in the enlarged sella turcica (asterisk). The mass is T1 hyperintense and T2 hypointense. It has suprasellar extension causing optic chiasmal compression (white arrowhead). There is no contrast enhancement
See this image and copyright information in PMC

References

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