title: Diagnosis of a craniopharyngioma after acute brainstem herniation in an emergency department.
abstract: A 9-year-old previously healthy girl presented with 3 weeks of intermittent emesis and headache to a community emergency department, where she had rapid decompensation due to increased intracranial pressure. Head computed tomography revealed a calcified suprasellar mass consistent with a craniopharyngioma. Despite medical and surgical intervention, the patient had progression of herniation with global cerebral infarction, and care was withdrawn. Although craniopharyngiomas are typically thought to be benign, slow-growing intracranial tumors, this case emphasizes the need for an expeditious diagnostic evaluation when symptoms that may be referable to intracranial hypertension are evident. Craniopharyngiomas and emergency management of intracranial hypertension are reviewed.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614-3394, USA. slweiss@childrensmemorial.org
authors.forename: Scott L
authors.initials: SL
authors.lastname: Weiss
authors.forename: Lindsay
authors.initials: L
authors.lastname: Wegg-Uzunlar
authors.forename: Robin M
authors.initials: RM
authors.lastname: Bowman
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Brannen
mesh_terms: D001933:Brain Stem; D002648:Child; D003397:Craniopharyngioma / Q000150:complications* / Q000175:diagnosis*; D018450:Disease Progression; D004636:Emergency Service, Hospital; D004677:Encephalocele / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis*; D012008:Recurrence; D014839:Vomiting / Q000209:etiology