RESUMO
Pituitary apoplexy is a rare and potentially life-threatening condition that usually occurs in the setting of a pre-existing pituitary tumor, which may be undiagnosed. There are a growing number of reports describing the pituitary apoplexy associated with coronavirus disease 2019 (COVID-19). We present the case of a 41-year-old man who presented with a gradually worsening headache for four days. It was a bilateral frontal headache of sharp quality with no radiation. He scored the headache as 9 out of 10 on the 10-point severity scale. He had no previous episodes of similar headaches. Fundoscopic examination revealed bilateral optic disc blurring suggestive of papilledema and cranial nerves examination revealed bilateral hemianopia. The patient was admitted for further investigation and management. As part of the admission protocol, the patent underwent a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which yielded positive results. Computed tomography demonstrated a large solid intrasellar mass with areas of high density suggesting hemorrhage along with a small amount of subarachnoid hemorrhage space in the left parietal lobe. The findings were consistent with pituitary apoplexy in the setting of pituitary macroadenoma. Intravenous hydrocortisone was administered. The patient underwent transsphenoidal surgical resection of the pituitary tumor, which resulted in significant improvement in the patient's symptoms. Pituitary apoplexy is a rare condition. The case suggests that COVID-19 may predispose to the development of pituitary apoplexy.
RESUMO
Trigeminal neuralgia is a rare condition characterized by brief, recurrent episodes of severe, unilateral, sharp pain limited to the sensory distribution of the trigeminal nerve. Neurovascular compression in the cisternal segment of the trigeminal nerve is considered the most common cause. Here, we present the case of an elderly man who had a two-year history of electric shock-like pain involving the right side of the face and associated facial spasms. The patient had a long-standing history of hypertension, diabetes mellitus, dyslipidemia, and previous coronary artery bypass graft surgery. The patient underwent magnetic resonance imaging, which revealed abnormal dilatation and tortuosity of the vertebral and basilar arteries, which resulted in compression of the facial and trigeminal nerves along with brainstem compression. Such findings were consistent with the diagnosis of vertebrobasilar dolichoectasia. The patient was given medical treatment in the form of carbamazepine, which resulted in satisfactory improvement in his symptoms. Vertebrobasilar dolichoectasia is a rare cause of neurovascular compression of the trigeminal and facial nerves that can lead to trigeminal neuralgia and facial hemispasm. Medical management should be attempted first, particularly in those patients who are not candidates for surgical interventions.
RESUMO
Hydatid disease is a parasitic infection caused by tapeworm Echinococcus. It has a worldwide distribution, but it is endemic in certain geographic locations. Hydatid disease can almost involve any body organ. However, cardiac involvement is exceedingly rare. We report the case of young girl presenting with chest pain and shortness of breath. She had a history of renal hydatid cyst for which she underwent surgical resection. After thorough investigation, she was found to have a hydatid cyst involving the left ventricular wall. The patient's family refused surgical management, and she had received medical treatment in the form of albendazole which showed dramatic improvement in her condition. This case shed light on the importance of having a high index of suspicion for this condition, particularly in those patients with a history of hydatid cysts in other organs.
RESUMO
Insulinoma is a rare neuroendocrine tumor that causes inappropriate release of insulin, resulting in episodes of hypoglycemia. It classically present with neuroglycopenic and autonomic sympathetic symptoms. These symptoms resolve promptly following glucose administration. Demonstration of elevated C-peptide level in the presence of hypoglycemia and absence of plasma sulfonylurea is suggestive of the diagnosis. Pre-operative localization of the tumor is essential. Herein, we present the case of middle-aged man who had a 6-month history of recurrent episodes of irritability and fatigue that resolved after eating. Pancreatic insulinoma was localized by computed tomography scan. The patient underwent successful resection of the tumor, and his symptoms showed complete resolution.
