Uncommon Presentation of Craniopharyngioma: A Case Report of Post-traumatic Intratumoral Hemorrhage Leading to Cerebral Infarct

Abstract

Craniopharyngiomas emanate from squamous cell remnants in the hypophyseal/pharyngeal duct region. This report details the unprecedented case of a 29-year-old male with adamantinomatous craniopharyngioma, who, following a motor vehicle collision (MVC), presented with post-traumatic intratumoral hemorrhage leading to acute basal ganglia infarct. The patient, previously subjected to subtotal resection, exhibited focal neurological deficits attributed to compression of lenticulostriate arteries due to the sudden increase in tumor volume. The patient, ineligible for thrombolysis or thrombectomy, was conservatively managed post-MVC. Subtotal resection occurred four months later. After one year, persistent right-sided weakness (2/5 motor power) remained, and the recommended stereotactic radiotherapy was declined by the patient. Notably, this instance represents the first documented case of post-traumatic intratumoral hemorrhage in adamantinomatous craniopharyngioma. This report distinguishes between adamantinomatous and papillary subtypes, noting their prevalence in different age groups. While these tumors commonly present with gradual vision changes, fatigue, and endocrine dysfunction, complications such as intra-tumoral hemorrhage remain rare. This report serves as an educational tool, shedding light on potential complications and urging increased vigilance in managing craniopharyngiomas.

Keywords: adamantinomatous craniopharyngioma; intratumoral hemorrhage; lenticulostriate artery; neuro radiology; supra sellar mass.

Figure 1. Multiple coronal sections of the T1-weighted images obtained post-gadolinium administration demonstrate the sellar-suprasellar solid-cystic lesion exhibiting mass effect on the right inferior frontal lobe (A), right basal ganglia (B, C), left basal ganglia (B, D) and left medial temporal lobe (B, D).

Figure 2. (A, B) Coronal section of post-contrast T1-weighted images obtained one year apart showing marked interval increase in the size of the lesion.

Figure 3. (A, B) Susceptibility-weighted imaging (SWI) obtained at the time of presentation (2020) showed a curvilinear hemorrhagic component along the anterior aspect of the lesion (white arrow in A) and a smaller hemorrhagic component posteriorly (black arrow in B).

Figure 4. (A, B) Diffusion-weighted imaging (DWI) revealed acute infarct in the left basal ganglia and corona radiata. (C) 3D reconstruction of time of flight (TOF) MR brain angiogram showed no large vessel occlusion or severe stenosis.

Figure 5. Axial and coronal sections of post-contrast T1-weighted maximum intensity projection images showing the lesion abutting the M1 segment of the left middle cerebral artery (arrows in A, B).