Patients with craniopharyngiomas most often present in 1 of 4 ways: raised intracranial pressure with accompanying hydrocephalus, visual loss, endocrine disturbance, or any of these in combination.
Such presentations may be acute (sudden visual loss or symptoms of intracranial hypertension) or more insidious in onset. Symptoms of raised intracranial pressure (headache, nausea, vomiting, diplopia, decreased level of consciousness) always suggest a potential intracranial mass and warrant urgent contrast-enhanced cranial imaging (preferably MRI). Visual loss also warrants intracranial imaging to exclude a mass affecting the optic nerves or chiasma.
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