A Case of Optic Neuritis Concomitant with Pituitary Tumor During Pregnancy.

BACKGROUND: Optic neuritis (ON) is unilateral painful optic nerve inflammation in a young healthy female diagnosed by excluding glaucoma. ON onset during pregnancy is rare, with only 2 cases reported to date. CASE DESCRIPTION: A 35-year-old previously healthy parous woman who was pregnant with her second child suffered rapidly progressive visual acuity loss. Magnetic resonance imaging (MRI) revealed a pituitary tumor. Emergency surgery was performed for optic nerve compression; however, her visual impairment worsened. Postoperative diffusion-weighted MRI showed high intensity in the bilateral optic nerves, and ON was diagnosed. Administration of methylprednisolone was effective, and her visual acuity recovered over 6 months. CONCLUSIONS: Associated pituitary macroadenoma complicated the true diagnosis of ON, because contrast medium cannot be used in pregnant women. The diffusion-weighted MRI findings were useful for diagnosing this complex clinical condition.

Neuroendoscopic Findings of Ventricular Wall in Adult Hemorrhagic Moyamoya Disease: Report of Two Cases.

Moyamoya disease usually manifests as ischemic events in childhood, and as more severe hemorrhagic events, including intraventricular hemorrhage, in adults. Recently, the indication for neuroendoscopic surgery has been extended to cast-formation intraventricular hematomas. However, detailed information about the use of neuroendoscopic surgery for the treatment of intraventricular hemorrhage associated with moyamoya disease has not been reported. We describe two cases of intraventricular hemorrhage with moyamoya disease; one in a 62-year-old and another in a 33-year-old women who both presented with severe neurological symptoms. Cerebral angiography revealed unilateral moyamoya disease. Neuroendoscopic surgery to remove the intraventricular hematoma was performed via bilateral frontal burr holes in both cases. Abnormal findings in the ventricle were observed only in the affected side and the intact side was normal. Specific findings of neuroendoscopic observation were dilated and tortuous vessels, intersection vessels, black-brown macules in the subependyma, and rattan blind-like (Japanese sudare) bleeding vessels. These characteristic neuroendoscopic findings may be useful for the exact diagnosis and treatment of intraventricular hemorrhage associated with moyamoya disease. Endoscopic evacuation of the ventricular hematoma may be important for intracranial pressure control in patients with intraventricular hemorrhage in adult moyamoya disease.

Acute basilar artery occlusion in a patient with left subclavian artery occlusion due to first rib anomaly: case report.

A previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud's phenomenon in the left hand and embolic occlusion of the basilar artery. Three-dimensional computed tomography angiography showed that the left subclavian artery was occluded as it passed over the abnormal first rib. Retrograde propagation of the thrombus from the site of arterial occlusion and/or reflux of embolic material was suspected. Medical therapy was started. The patient underwent resection of the anomalous rib. Postoperative angiography demonstrated that the subclavian artery was recanalized with almost normal distal flow. The basilar artery was also recanalized. Thoracic outlet syndrome due to a first rib anomaly may cause stroke.

Transcriptional regulation of the human PRL-releasing peptide (PrRP) receptor gene by a dopamine 2 Receptor agonist: cloning and characterization of the human PrRP receptor gene and its promoter region.

PRL-releasing peptide receptor (PrRPR) mRNA was expressed in pituitary adenomas but was not detected in patients treated with bromocriptine, a specific agonist of dopamine 2 (D2) receptor. Although medical treatment with bromocriptine is effective for patients with pituitary adenomas, little is known about the molecular mechanisms of gene regulation mediated by D2 receptors. The cloned human PrRPR gene spanned approximately 2.0 kb and contained two exons and one intron. Two functional polyadenylation signals located at 510 and 714 bp downstream from the stop codon. A primer extension analysis demonstrated two major transcriptional start sites at 139 and 140 bp upstream from the translational start site and an additional minor site at -161. The promoter region contained several putative binding sites for transcriptional factors including pituitary-specific transcription factor (Pit 1), activator protein 1 (AP-1), and specificity protein (Sp1), but no typical TATA or CAAT box. This promoter showed the strong activity in the pituitary-derived GH4C1 cells, and the region between -697 and -596 bp was responsible for the stimulation both by forskolin and overexpression of cAMP response element binding protein (CREB). These stimulations were significantly suppressed by incubation with bromocriptine in a dose- and time-dependent manner, and the mutant CREB (S133A) completely abolished the inhibitory events of bromocriptine. However, EMSA studies demonstrated that CREB did not bind to this region, to which an approximately 60-kDa protein was strongly bound, and that antibodies against CREB, c-Fos, and Sp1 did not supershift this complex. Furthermore, the amount of this unknown protein was apparently reduced by treatment with bromocriptine. A series of mutation analyses demonstrated that the specific sequence, 5'-cccacatcat-3', was required for both the binding to the 60-kDa protein and the repression by bromocriptine. Therefore, the transcriptional repression of the PrRPR gene by bromocriptine required CREB but was independent of direct binding of CREB to the gene and that the sequence -663 -- -672, 5'-cccacatcat-3', bound to the 60-kDa protein appeared to be critical for this event.