Clinical Study of Craniopharyngiomas Occuring in Persons Over 40

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Abstract
The records of all cases of craniopharin-giomas admitted to the N.Y. Neurological Institute between 1932 and 1949 were studied. Of a total of 83 cases of hypophyseal duct tumors admitted during these years only 5 histologically verified cases occurred in individuals over 40. These 5 cases and 1 studied at another hospital are described in detail. From these case histories it is apparent that Rathke pouch tumors occurring in older persons do not have a typical clinical picture, and often are unsuspected until air studies are done. Unlike younger subjects in whom headache is almost invariably an early symptom, heachaches occurred late in the clinical course in half the cases. Signs of increased intracranial pressure rarely occur in older persons. Visual disturbances occurred sooner or later in every case. Visual field defects are not of differential value since there is great variation in the type and extent of visual defects encountered. In adults the most frequent defect is a bitemporal hemianopsia. While papilledema is very common early in the course of the disease in children, temporal pallor of the discs or frank optic atrophy is more usual in adults. The fundi are often normal. Of great clinical significance and an aid to localization are symptoms produced by involvement of the hypothalamus (i.e., polydipsia, polyuria, polyphagia, hyperthermia, somnolence, and pulse and temperature dissociation), and endocrine disturbances of a regressive sexual nature. Sympotms and signs due to pressure upon the brain stem, basal ganglia, thalamus and efferent cerebellar pathways are frequent. The cerebrospinal fluid exhibits no consistent abnormalities. Suprasellar calcifications were found in only half the cases.

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