Post-Surgery Memory Confusion in Craniopharyngioma Patients: Seeking Help

Memory disturbances after craniopharyngioma surgery?

Dear Dr.
Ding,
My wife underwent a craniopharyngioma resection surgery in March of this year, and since then, her memory has been in a state of confusion.
She cannot distinguish between day and night, and she forgets what she did or said just a minute ago.
Her personality has changed; she has become anxious, stubborn, and irritable.
She does not accept corrections to her mistakes and spends her days fabricating stories that connect events from different times and places.
At times, she claims that her child is missing, and at other times, she insists on going out of town for a wedding.
If we do not allow her to go out or drive, she throws tantrums.
Additionally, due to diabetes insipidus, she requires daily medication for cortisol and thyroid hormone supplementation, which has resulted in an increased appetite (though we are unsure if this is directly related).
She weighs nearly 80 kg and still feels unsatisfied after eating.
We have consulted her primary surgeon, rehabilitation specialists, and psychiatrists, but we have not received any proactive treatment recommendations.
However, her behavior has caused significant distress for our family, and we are unsure what kind of medical assistance to seek.

Mr. Zeng, 40~49 year old female. Ask Date: 2010/08/03

Dr. Ding Xianwei reply Neurosurgery

Craniopharyngiomas are tumors that primarily grow near the hypothalamus or the pituitary gland, and as a result, many patients experience complications related to hormonal deficiencies after surgery.
However, symptoms of psychiatric disorders are relatively rare.
Currently, the symptoms may only be managed with medications related to psychiatric conditions.
Regarding the sensation of not being full, it may be due to damage to the satiety center in the hypothalamus, so dietary restraint is the only way to address this issue.
It is recommended that you consult with additional physicians for better care.

Reply Date: 2010/08/03

More Info

Post-surgery memory confusion and behavioral changes in patients who have undergone craniopharyngioma resection can be quite challenging for both the patient and their caregivers. It is important to understand that craniopharyngiomas are tumors that often affect the hypothalamus and pituitary gland, which play crucial roles in hormone regulation and various neurological functions. The surgical removal of such tumors can lead to a range of complications, including hormonal deficiencies and cognitive changes.

In your case, the memory confusion and behavioral changes your spouse is experiencing may be attributed to several factors. First, the surgical intervention itself can lead to temporary or even permanent changes in cognitive function. This is particularly true if the tumor was located near critical areas of the brain responsible for memory and behavior. Post-operative cognitive dysfunction (POCD) is a recognized phenomenon where patients experience difficulties with memory, attention, and executive function following surgery, especially in older adults.

The symptoms you describe—such as confusion about time, memory lapses, anxiety, irritability, and the creation of fictitious narratives—may indicate a disruption in the brain's normal functioning. These changes can be exacerbated by hormonal imbalances resulting from the surgery. For instance, deficiencies in hormones like cortisol and thyroid hormones can lead to mood swings, increased appetite, and other behavioral changes. The fact that your spouse is experiencing polydipsia and polyuria (as indicated by the mention of diabetes insipidus) suggests that the hypothalamus may be affected, further complicating the clinical picture.

Given the complexity of your spouse's condition, it is crucial to seek a multidisciplinary approach to treatment. Here are some recommendations:
1. Neurology Consultation: A neurologist can assess the cognitive changes and determine if they are related to the surgery or other underlying conditions. They may recommend neuropsychological testing to evaluate memory and cognitive function more thoroughly.

2. Endocrinology Consultation: Since your spouse is experiencing hormonal deficiencies, an endocrinologist can help manage these issues. Hormone replacement therapy may be necessary to address deficiencies in cortisol and thyroid hormones, which could help stabilize mood and cognitive function.

3. Psychiatric Evaluation: A psychiatrist can provide support for the behavioral changes and may prescribe medications to help manage anxiety, irritability, or other mood disorders that may have arisen post-surgery.

4. Cognitive Rehabilitation: Engaging in cognitive rehabilitation therapy can help improve memory and cognitive function. This may involve working with a speech therapist or occupational therapist who specializes in cognitive rehabilitation.

5. Support Groups: Connecting with support groups for caregivers and patients with similar conditions can provide emotional support and practical advice on managing the challenges associated with post-surgical recovery.

6. Lifestyle Modifications: Encouraging a healthy lifestyle, including a balanced diet, regular physical activity, and mental exercises, can also contribute positively to cognitive recovery.

7. Monitoring and Follow-up: Regular follow-up appointments with the surgical team and other specialists are essential to monitor your spouse's progress and make necessary adjustments to the treatment plan.

In conclusion, while the situation is undoubtedly complex and challenging, a comprehensive approach involving various specialists can significantly improve your spouse's quality of life and cognitive function. It is important to advocate for your spouse's needs and seek out the appropriate medical professionals who can provide the necessary support and treatment.

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