A Sedimentation Level in Pituitary Adenoma on Magnetic Resonance Imaging

We present a rare case of a pituitary adenoma revealing a sedimentation level on MRI, which has not been previously documented. This 55-year-old woman was referred with the diagnosis of craniopharyngioma. She presented with four-month history of progressive headache and visual dimness. Neurological examination revealed a bitemporal hemianopsia and decreased visual acuity. Laboratory data including endocrine examination were unremarkable. An additional three-dimensional MRI was taken for further evaluation, and demonstrated a sedimentation level within the tumor. The patient underwent transcranial removal of the tumor. About 12cc of dark-red blood was aspirated from the tumor. Histological examination revealed a pituitary adenoma with hemorrhage. Postoperatively, the patient showed gradual improvement of visual function. Considering that the pituitary adenoma is one of more common tumors that cause tumoral bleeding, a cystic sellar tumor that has a sedimentation level should be sought first for a pituitary adenoma rather than a craniopharyngioma. This may have an important impact when deciding surgical approach.

Sedimentation Level in Chronic Sudural Hematoma Visible on Computerized Tomography

Authors report five cases of chronic subdural hematoma that showed a specific sedimentation sign on computerized tomography(CT) as a clear interface dividing the hematoma into two parts:an upper hypodense and a lower hyperdense zone. All patients had definite history of head trauma more than 1 month before they developed acute disturbance of consciousness and pronounced hemiparesis. We had analyzed the clinical importance of this sedimentation level and reviewed the available literature. This finding was considered as a specific CT sign indicating a significant amount of recent hemorrhage within the subdural hematoma that was sufficiently old to result in its contents being homogenous prior to rebleed and clinically manifested by acute deterioration.