====== Suprasellar arachnoid cyst clinical features ======

[[Suprasellar arachnoid cyst]]s can be diagnosed as incidental in asymptomatic patients
((Monsalve G, Luque JC. Giant suprasellar arachnoid cyst. A case with severe
brain stem compression: an incidental finding in a head trauma. Pediatr
Neurosurg. 2007;43(2):174-6. PubMed PMID: 17337937.)).

There are three reported cases of spontaneous disappearance of a suprasellar arachnoid cyst
((Moon KS, Lee JK, Kim JH, Kim SH. Spontaneous disappearance of a suprasellar
arachnoid cyst: case report and review of the literature. Childs Nerv Syst. 2007 
Jan;23(1):99-104. Epub 2006 Aug 30. PubMed PMID: 16944178.)).

[[Obstructive hydrocephalus]] is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst
((Al-Holou WN, Terman S, Kilburg C, Garton HJ, Muraszko KM, Maher CO. Prevalence
and natural history of arachnoid cysts in adults. J Neurosurg. 2013
Feb;118(2):222-31. doi: 10.3171/2012.10.JNS12548. Epub 2012 Nov 9. PubMed PMID:
23140149.))
, and can have varied presentations with [[sign]]s and [[symptom]]s of [[obstructive hydrocephalus]]
by compressing the [[third ventricle]] that require urgent decompression. These patients may present with nonfocal symptoms that can quickly lead to a life-threatening condition if not accurately diagnosed and treated. 

Urgent endoscopic third ventriculostomy results in normalization of [[intracranial pressure]], return of normal CSF flow, and relief of symptoms
((Mattox A, Choi JD, Leith-Gray L, Grant GA, Adamson DC. Guidelines for the
management of obstructive hydrocephalus from suprasellar-prepontine arachnoid
cysts using endoscopic third ventriculocystocisternostomy. Surg Innov. 2010
Sep;17(3):206-16. doi: 10.1177/1553350610377212. Epub 2010 Aug 5. Review. PubMed 
PMID: 20688773.)).

===Other clinical features===
[[Visual disturbance]]

[[Endocrine disease]].

Distortion of the pituitary infundibulum can also result in endocrine dysfunction

Gait [[ataxia]].

Rarely [[bobble head doll movement]]
((Wiese JA, Gentry LR, Menezes AH. Bobble-head doll syndrome: review of the
pathophysiology and CSF dynamics. Pediatr Neurol. 1985 Nov-Dec;1(6):361-6.
Review. PubMed PMID: 3916908.))
((Fioravanti A, Godano U, Consales A, Mascari C, Calbucci F. Bobble-head doll
syndrome due to a suprasellar arachnoid cyst: endoscopic treatment in two cases. 
Childs Nerv Syst. 2004 Oct;20(10):770-3. PubMed PMID: 15057560.))
((Van Beijnum J, Hanlo PW, Han KS, Ludo Van der Pol W, Verdaasdonk RM, Van
Nieuwenhuizen O. Navigated laser-assisted endoscopic fenestration of a
suprasellar arachnoid cyst in a 2-year-old child with bobble-head doll syndrome. 
Case report. J Neurosurg. 2006 May;104(5 Suppl):348-51. PubMed PMID: 16848093.))
((Alexiou GA, Sfakianos G, Prodromou N. Giant suprasellar arachnoid cyst with
head bobbing. Mov Disord. 2013 Aug;28(9):1216. doi: 10.1002/mds.25511. Epub 2013 
Aug 2. PubMed PMID: 23913743.
))
((Hagebeuk EE, Kloet A, Grotenhuis JA, Peeters EA. Bobble-head doll syndrome
successfully treated with an endoscopic ventriculocystocisternostomy. Case report
and review of the literature. J Neurosurg. 2005 Sep;103(3 Suppl):253-9. PubMed
PMID: 16238079.)).

Ramesh et al. present three cases with bobble-head doll syndrome associated with a large suprasellar arachnoid cyst and obstructive hydrocephalus
((Ramesh S, Raju S. Suprasellar arachnoid cyst presenting with bobble-head doll syndrome: Report of three cases. J Pediatr Neurosci. 2015 Jan-Mar;10(1):18-21.doi: 10.4103/1817-1745.154321. PubMed PMID: 25878736; PubMed Central PMCID:PMC4395937.)).

===Precocious puberty===
Precocious puberty is rarely the presenting sign.
It is characterized by early onset, patent symptoms and frequent association with [[growth hormone]] deficiency. The latter represents a further risk of short stature. Evolution of precocious puberty varied from one case to another, without any relation with the quality of control of the arachnoid cyst and associated hydrocephalus. Half-yearly follow-up of height and bone age allowed for deciding a suppressive treatment of precocious puberty and a substitutive growth hormone therapy when needed
((Brauner R, Pierre-Kahn A, Nemedy-Sandor E, Rappaport R, Hirsch JF. [Precocious
puberty caused by a suprasellar arachnoid cyst. Analysis of 6 cases]. Arch Fr
Pediatr. 1987 Aug-Sep;44(7):489-93. French. PubMed PMID: 3426371.)).


Various forms of symptomatic and idiopathic epilepsy and other psychoneurological disorders (disorders of behavior and emotions, obsession-compulsion syndromes, stereotypias, aggression, compulsive ideas and movements, anorexia or hypothalamic obesity) coincident with one or more endocrine disorders such as precocious or delayed puberty, multihormonal pituitary deficiency, panhypopituitarism and secondary hypothyroidism were detected 
((Starzyk J, Kwiatkowski S, Kaciński M, Kroczka S, Wójcik M. [Structural CNS
abnormalities responsible for coincidental occurrence of endocrine disorders,
epilepsy and psychoneurologic disorders in children and adolescents]. Przegl Lek.
2010;67(11):1120-6. Polish. PubMed PMID: 21442961.)).

Presenting with signs of [[normal pressure hydrocephalus]].
((De Bonis P, Novegno F, Tamburrini G, Anile C, Pompucci A, Mangiola A. Teaching
NeuroImage: Prepontine-suprasellar arachnoid cyst presenting with signs of normal
pressure hydrocephalus. Neurology. 2008 Feb 5;70(6):e26. doi:
10.1212/01.wnl.0000296823.01603.44. PubMed PMID: 18250284.
)).