A 75-year-old woman with a known intracranial mass referred to our outpatient clinic. The lesion was incidentally discovered after a head computed tomography (CT) scan that she had in the past for the evaluation of a confusion episode secondary to hypoglycemia (diabetes mellitus being the only comorbidity in this patient). Magnetic resonance imaging (MRI) of her brain revealed a cystic sellar mass with mass effect on the right lateral ventricle []. The patient had ophthalmologic and endocrinologic evaluations that demonstrated a left temporal, a right superior temporal visual field deficit, and panhypopituitarism. Based on these imaging and clinical findings, the diagnosis of a craniopharyngioma was made. She was then placed on steroid therapy as well as hormone replacement therapy, and surgical resection was planned. In the interim, she began developing severe lower extremity weakness that delayed surgery. A diagnosis of steroid-induced myopathy was made.\nImmediately after the evaluation of her lower extremity weakness, the patient presented to the ED with an acute onset of altered mental status. Her Glasgow Coma Scale (GCS) score on initial presentation was 10. Noncontrast head CT imaging demonstrated changes in the density of the cyst and the density of the ventricular cerebrospinal fluid (CSF) []. Subsequent MRI of the brain was strongly suggestive of intraventricular rupture of the cyst []. Intraventricular cyst rupture was confirmed by a lumbar puncture that demonstrated marked pleocytosis with elevated levels of cholesterol and lactate dehydrogenase identified by CSF analysis. Given these findings, a diagnosis of chemical ventriculitis was made.\nThe patient was initially started on high-dose steroid therapy with significant improvement of her level of consciousness (GCS: 13/15). Once her clinical condition was medically optimized, the patient was taken to the operating room for endoscopic-assisted intracystic placement of an Ommaya reservoir []. Cytopathologic analysis of the aspirate revealed proteinaceous material, blood, and histiocytes, some with hemosiderin. She underwent shunt placement for continued ventriculomegaly 5 days after Ommaya reservoir placement. Her condition improved, and she was discharged from the Intensive Care Unit within 2 weeks from her admission.
MO, a 24-year-old male presented at an outside hospital with headaches of a few months in duration with a loss of libido and decreased energy levels. His endocrine workup revealed hypopituitarism and imaging showed a 2.5 cm sellar-suprasellar solid cystic mass for which he underwent a cyst aspiration and biopsy. He subsequently had tumor progression and was treated with GKRS. Long-term follow-up at 9 years continues with the patient remaining stable and requiring no further interventions.