A Case Report on Nursing Care of Craniopharyngioma

We present a case of a rare craniopharyngioma in the left temporal lobe that developed after no prior brain trauma or surgery. Craniopharyngiomas are slow-growing benign tumours that affect the sellar and parasellar portions of the central nervous system. The incidence of this tumour is roughly Case Study Zade et al.; JPRI, 33(60B): 550-555, 2021; Article no.JPRI.78416 551 2/100,000. The majority of individuals experience neurological (headaches, visual abnormalities) and endocrine (growth retardation, rapid puberty) disorders over time 13. Case presentation: After undergoing biopsy, M.R.I., and C.T., a 45 year old man was admitted to Acharya Vinoba Bhave Rural Hospital on 13/02 2021 with the main complaint of blurring of vision in right eye, headache, polyurea since 5 month, polydipsia, and altered behavior since 2 month. After a C.T. Scan, the patient was diagnosed with a craniopharyngioma. Conclusion: The patient was admitted to Acharya Vinoba Bhave Rural Hospital with blurred vision in the right eye, headache, polyurea, polydipsia, and altered conduct as his known causes. Going to follow all of the tests, the patient was diagnosed with a craniopharyngioma still the patient requires medical attention and appropriate nursing care.


INTRODUCTION
Craniopharyngiomas account for 1% to 5% of all primary intracranial tumours (CP). Non-glial tumours that grow slowly are more common in adolescents and teenagers, as well as individuals over the age of 50. Cancers that grow near the hypothalamus in the brain are known as craniopharyngiomas. The aetiology of these lesions is unknown, according to WHO classification, and they are benign Grade-1 tumours. They are, however, frequently categorised as malignant since they have the potential to cause medical issues by interfering with neuroendocrine systems or generating cognitive disorders [1].

Presentation of Case
After undergoing biopsy, M.R.I ,and C.T. a 45 year old man was admitted in neuro ward with the main complaint of blurring of vision in right eye, headache, polyurea since 5 month, polydipsia, and altered behavior since 2 month after a C.T. Scan , the patient was diagnosed with a craniopharyngioma .

Clinical Diagnosis
Craniopharyngioma is a low-grade embryonic malformation of the sellar/ parasellar area. Based on all investigations by physicians, diagnosed through biopsy and marked multiple, abnormal, brownish tissue piece aggregating 6 x 5 x 1 cm.

PATHOLOGICAL DISCUSSION
Multiple irregular, brownish tissue fragments measuring 6 x 5 x 1 cm were found during biopsy.

Physical Examination
The patients overall appearance was well and nourished but , since he is not healthy, he is sluggish by nature, and he has not retained with his hygiene and personal grooming . owing to the patient unconsciousness, his emotional health could not be measured. The vital signs of the patient change over time and in relation to their illness. He has visual impairment due to direct infiltration and compression of the visual pathway, visual field defects, typically bitemporal hemianopia, and abnormal pupillary responses, as determined by an eye examination.

Medical Management
The patient is under treatment with combination of antibiotic, antiepileptic, analgesics, diuretic, antiemetic and antifibrinolytic compound. The prescribed drugs were administered as once a day via injection like: Adrenaline 1ml: Adrenaline Tartrate Injection was administered in order to avoid severe allergic reaction and cardiac arrest intramuscularly in OD.

Ceftriaxone
1gm: Gonorrhoea, pelvic inflammatory disease, meningitis (infection of the membranes that surround the brain and spinal cord), and infections of the lungs, ears, skin, urinary tract, blood, bones, and the joints are all treated with ceftriaxone injection. Cold, flu and other viral infections do not respond to ceftriaxone injection.
Dexamethasone 2ml: Allergic reactions, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders are all addressed with dexamethasone. Dexamethasone has a longer quarter than hydrocortisone and is more potent.
Furesemide 2ml: furesemide also known as lasix is loop diuretics. Furesemide has a couple of contraindications, hypersensitivity, cross sensitivity with thiazides and sulfonamides, hepatic coma and anuria, diabetes, low magnesium in the blood and low potassium in the blood are all potential dangers.
Levetricetam: Levetricetam is an antiepileptic drug. Side effects of levetricetam is dizziness, headache, irritability, mood and behavior changes.
Ondesteron 2ml: The injection of ondansetron is used to prevent nausea and vomiting.
Phenytoin 100mg: Phenytoin is used to prevent and control seizures.
Tranexamic acid 5ml: Tranexamic acid works by inhibiting prolonged bleeding by slowing the breakdown of blood clots. It belongs to something like the antifibrinolytics class of drugs.

Surgical Management
Craniotomy done with emergency re explore in view of bleeding from residual tumor. The surgical removal of parts of the skull to expose the brain is known as cranial osteotomy. A craniotomy is a procedure that is used to diagnose, remove, or treat a brain tumour. General anesthesia was used for the cranial surgery.

Intolerance to Physical Activity
Chart 3. Nursing diagnosis: Intolerance to physical activity related to surgical procedure secondary to prolonged bed rest 4] Its likely that this will help you learn more or allow you to learn at your own speed.

DISCUSSION
A case study that yielded a beneficial result Mr. X, a 51-year-old man, had symptoms such as decreased motivation at work, easy fatigability for seven months, infrequent falls with giddiness for six months, recent memory impairment and increased appetite for four months, inability to walk steadily for two months, and bladder incontinence for one month, as well as symptoms that suggested polydipsia and polyuria [2].Patients who had surgery followed by radiation, as well as those who were 18 or younger compared to those who were older, men compared to women, and those who did not have a headache, had a better prognosis, however these differences were not statistically significant [3]. Papillary type craniopharyngioma showed a lower recurrence rate than adamantinomatous type craniopharyngioma, even after surgical removal. The histologic classification of craniopharyngiomas is useful in determining therapy and follow-up decisions, especially in adults [4]. In this case of craniopharyngioma in the left temporal lobe, there was no history of head trauma or surgery [5]. Craniopharyngiomas are rare intracranial tumours that frequently cause neurological problems [6]. A papillary craniopharyngioma with the potential to spread On the other side of the craniotomy, the tumour expanded [7]. The large head circumference at birth, the size of the tumour, blindness, and hemiparesis seen before the age of five months suggested a prenatal process that went unnoticed due to inadequate gestational monitoring [

CONCLUSION
The patient was admitted neuro ward with blurred vision in the right eye, headache, polyurea, polydipsia and altered conduct as his known causes. Going to follow all of the tests, the patient was diagnosed with a craniopharyngioma still, the patient requires medical attention and appropriate nursing care.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors. Stephatephanie puged, Jacques Graiil and Christan sainte rose. 14. Craniopharyn giomas, Margaret Alvarez.