| 본문 : Rathke’s cleft cysts (RCCs) are benign, sellar and/or suprasellar lesions originating from the remnant of Rathke’s pouch. Although a common finding, symptomatic cases are rare. Furthermore, cranial neuropathy is extremely rare. We present a case of woman who had a RCC causing progressive oculomotor nerve palsy, an uncommon manifestation of RCC.
A 54-year-old woman without a significant past medical history presented with recent onset
of diplopia. Her visual acuity was 20/20 in both eyes and no visual field defects were found in the visual field testing. She manifested a 12 prism diopters(PD) left exotropia in the primary position which was 25 PD in attempted right gaze and 5 PD in left gaze. In her left eye we found mild ptosis and limited ocular motility in adduction (-0.5) only. After a few days, she manifested a 35 PD left exotropia with 4 PD left hypotropia in primary position which was 40 PD in attempted right gaze and 6 PD in left gaze. She had a progressive and pronounced limitation of ocular motility of her left eye. Also, her ptosis of left eye was worsen. Brain magnetic resonance(MR) imaging showed a multi-septated cystic mass in sella and suprasella area. Bulging of left side of mass toward left cavernous sinus was noted and partial invasion of cavernous sinus was suspected. The patient underwent a transsphenoidal surgery. By 8 weeks postoperatively, the patient had marked improvement in her visual symptoms including ptosis and diplopia and near complete resolution of the left oculomotor nerve palsy.
Symptomatic RCCs are usually rare. Among the symptoms, headache and pituitary dysfunction are the most prevalent manifestations of symptomatic RCCs. The present case of RCC is interesting due to its atypical clinical features of only progressive oculomotor nerve palsy without headache, visual field defect and endocrine dysfunction.
|