A 4-Year-Old Male Who Has a Persistent, Severe Headache

Abstract

1. Osman Farooq, MD* 2. Zebunnissa Memon, MD† 3. Nicholas Saikali, MD‡ 4. Thomas J. Langan, MD* 1. *Department of Pediatric Neurology, University of Buffalo, SUNY, Buffalo, NY. 2. †Department of Pediatrics, University of Buffalo, SUNY, Buffalo, NY. 3. ‡Department of Neurology, University of Buffalo, SUNY, Buffalo, NY. A 4-year-old boy presents to the emergency department (ED) with a 10-day history of headaches. He was seen in the same ED 1 week before for a 2- to 3-day history of headache. The patient's headache improved after he was given acetaminophen, and he was discharged from the ED with instructions to parents to administer acetaminophen on an as-needed basis. However, over the following week, the headaches increased in frequency and severity, and the patient was brought to his pediatrician complaining of global headaches, difficulty reading at school, and difficulty walking up and down stairs. The patient was referred for further evaluation. On assessment, vital signs are within normal limits. Physical examination is significant for generalized somnolence, right optic disc pallor, bitemporal hemianopsia, and a slight left-sided facial droop. Mild weakness is noted in the left upper extremity, both proximally and distally. Deep tendon reflexes are appropriate and symmetrical in all extremities. A computed tomography (CT) scan of the head (Fig 1) suggests the diagnosis. Figure 1. CT scan of the head of 4-year-old male with persistent headache. The CT scan of the head (Fig 1) revealed a midline hypodense cystic mass in the sellar region with areas of hyperdensity, suggestive of calcifications. Magnetic resonance imaging (MRI) of the brain further revealed an enhancing heterogeneous mass with solid and cystic components (Fig 2). Based on the location and appearance of the mass, the patient was strongly suspected of having a craniopharyngioma and scheduled for surgical resection. Figure 2. Axial, coronal, and sagittal views of MRI with contrast revealing a heterogeneously enhancing solid and cystic mass extending upward from …