An Unusual Intracranial Inflammatory Process of Unknown Origin

Khaled Badran, Mohamed Abdelsadq, Athar Abbas, Jonathan O’Riordan, Avinash Kumar Kanodia*, Graham Leese and Kismet Hossain-Ibrahim

An Unusual Intracranial Inflammatory Process of Unknown Origin

We present an unusual case of steroid responsive inflammatory condition,
involving sellar suprasellar region with further ependymal lesions.

This is complicated by previous surgery due to pituitary adenoma,
not thought to related to inflammatory process.

The patient responded well to steroids, but deteriorated due to development of hydrocephalus caused
by obstruction due to adhesions. Despite extensive literature review and consideration of all known pathological
conditions, it was concluded that the condition represented another inflammatory entity not yet
fully characterised.

The case also highlights that despite the steroid responsive nature of the
condition, the ependymal involvement can result in progressive acute obstructive
hydrocephalus with clinical deterioration.

This case also suggests close follow-up and early imaging for
early detection and treatment of this complication.

This case report pertains to a 46-year-old male Caucasian who had endoscopic treatment
for a pituitary adenona three years previously. He required replacement hydrocortisone and
testosterone. Prior to the surgery, he was not known to have any other neurological issues.

A year after surgery following minor trauma, he underwent a computed tomography
scan of the head. This confirmed no residual pituitary tumour.

He was somewhat non-compliant with endocrine follow-up.
Surveillance magnetic resonance imaging imaging 2 years following
initial surgery demonstrated post-up change with some enhancing
tissue scaling the pituitary stalk and hypothalamic region; this was not clearly seen on the
previous CT scan, possibly due to different modalities and absence of contrast imaging.

Two months later, he developed polydipsia, fatigue and a partial left-sided homonymous visual
field deficit. There was progressive confusion with fluent dysphasia and inattention. He was
pyrexical. Gaze evoked nystagmus was present to the right. The rest of his examination was

Neuro Open J. 2017; 4(1): 25-30. doi: 10.17140/NOJ-4-126