Craniopharyngioma physical examination

The diagnosis of craniopharyngioma is often made late after the initial appearance of symptoms. The clinical picture at the time of diagnosis often dominated by nonspecific manifestations of intracranial pressure like headache, nausea and vomiting. Primary manifestations are visual impairment and endocrine deficits.

• Both general physical exam and neurological exam is indicated in suspected cases of craniopharyngioma.^[1]

• Signs and symptoms may be related to various hormonal imbalances.^[2]

• Puffiness and non-pitting edema
• Slow return phase of deep tendon reflexes
• Hypoventilation and decrease in cardiac output
• Pericardial and pleural effusions
• Constipation
• Anemia
• Decreased mental function
• Psychiatric changes

• • Orthostatic hypotention
  • Gastrointestinal symptoms which include anorexia, nausea and vomiting.^[3]
  • Weight loss
  • Hypoglycemia
  • Lethargy
  • Confusion
  • Psychological disturbances such as psychosis and intolerance to stress.^[1]

• Compression of the infundibulum can lead to the common presentation of diabetes insipidus.^[4]
• Other possible presentation in physical exam are:^[5]
  • Hypovolemia
  • Decreased cardiac output
  • Decreased renal blood flow with azotemia
  • Fatigue
  • Weight loss
  • Cardiac arrhythmias due to hyperkalemia

• Visual field testing may reveal many patterns of visual loss but most frequently found visual problem is bitemporal hemianopsia.^[4]
• It results from the involvement compression of the optic chiasm and tracts. ^[5]
• Formal visual field testing by ophthalmology is recommended as part of the initial work up.
• Serial testing can be used in follow up to monitor tumor growth or recurrence.^[3]
• Signs of increased intracranial pressure which include horizontal double vision and papilledema should be checked for in any patient suspected of having an intracranial mass.

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