ABSTRACT
Thirty-seven patients with pituitary apoplexy were analyzed with an emphasis on clinical presentation and visual outcome. Their mean age was 56.6 years, with a male to female ratio of 2:1. Presenting symptoms included headache (95%), vomiting (69%), ocular paresis (78%), and reduction in visual fields (64%) or acuities (52%). Computed tomographic scanning correctly identified pituitary hemorrhage in only 46% of those scanned. Thirty-six patients underwent transsphenoidal decompression. By immunostaining criteria, null-cell adenomas were the most frequent tumor type (50%). Long-term steroid or thyroid hormone replacement therapy was necessary in 82% and 89% of patients, respectively. Long-term desmopressin therapy was required in 11%, and 64% of the male patients required testosterone replacement therapy. Surgery resulted in improvement in visual acuity deficits in 88%, visual field deficits in 95%, and ocular paresis in 100%. Analysis of the degree of improvement in preoperative visual deficits with the timing of the surgery demonstrated that those who underwent surgery within a week of apoplexy had significant recovery in their visual acuities. In the stable, conscious patient with residual vision in each eye, surgical decompression should be performed as soon as possible, because delays beyond 1 week may retard the return of visual function.
Subject(s)
Adenoma/surgery , Pituitary Apoplexy/surgery , Pituitary Neoplasms/surgery , Adenoma/diagnosis , Adenoma/pathology , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurologic Examination , Pituitary Apoplexy/diagnosis , Pituitary Apoplexy/pathology , Pituitary Gland/pathology , Pituitary Hormones/analysis , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/pathology , Postoperative Complications/diagnosis , Tomography, X-Ray ComputedABSTRACT
We present an unusual case of neurocysticercosis supported by characteristic lesions on computed tomography and positive serum and CSF titres. The patient came to medical attention on various occasions over a decade with three clearly separate neurological presentations (acute psychosis, cerebral infarction, and hydrocephalus) before diagnosis was made.
Subject(s)
Brain Diseases/diagnosis , Cysticercosis/diagnosis , Neurologic Examination , Adult , Brain Diseases/complications , Brain Diseases/therapy , Combined Modality Therapy , Cysticercosis/complications , Cysticercosis/therapy , Dexamethasone/administration & dosage , Female , Follow-Up Studies , Humans , Hydrocephalus/etiology , Neurocognitive Disorders/etiology , Praziquantel/administration & dosage , Tomography, X-Ray Computed , Ventriculoperitoneal ShuntABSTRACT
Spinal subdural haematoma is a rare condition, usually seen in association with lumbar puncture or a bleeding disorder. It carries a high morbidity and mortality, and successful treatment requires prompt surgical intervention. We present a case of mixed spinal subarachnoid and subdural haemorrhage complicating failed spinal anaesthesia combined with anti-coagulation in an elderly woman, together with a review of the literature.
Subject(s)
Hematoma, Subdural/etiology , Iatrogenic Disease , Spinal Cord Diseases/etiology , Spinal Puncture/adverse effects , Aged , Aged, 80 and over , Anesthesia, Epidural/adverse effects , Female , Hematoma, Subdural/pathology , Humans , Spinal Cord Diseases/pathologyABSTRACT
The case of an infant is reported in which hemifacial spasm due to a ganglioglioma of the fourth ventricle was relieved by surgery. Previously described causes of hemifacial spasm are summarized, and the relevance of this case to theories on the pathogenesis of the condition is discussed.
Subject(s)
Cerebral Ventricle Neoplasms/complications , Facial Muscles , Neuroblastoma/complications , Spasm/etiology , Cerebral Ventricle Neoplasms/surgery , Child, Preschool , Humans , Male , Neuroblastoma/surgeryABSTRACT
Lumbar disc prolapse managed surgically is occasionally complicated by a recurrent ipsilateral prolapse of the residual disc material at the same level, but only rarely by prolapse on the contralateral side at that level. We present a case of the latter, successfully managed by a second microdiscectomy, and review the frequency of such cases in previous series.
