Unusual presentation of recurrent pituitary abscess. A case report and literature review.

Pituitary abscess is a rare pituitary pathology which may be potentially life-threatening if not treated. Therefore, early accurate diagnosis and therapy are extremely important. However, the clinical diagnosis is difficult because there are no clinical symptoms characteristic of pituitary abscess. It is frequently indistinguishable clinically or with neuroimaging studies from other pituitary lesions. The MR diagnosis of pituitary abscess must be suspected in cases of sellar cystic mass with a peripheral rim enhancement after contrast administration. It must be highlighted that pituitary abscess may show various signal intensity on T1-weighted images, as in our case, making the diagnosis even more difficult. We report an unusual case of a 66-year-old woman who presented with a recurrent pituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images. The woman was operated on three times, using transsphenoidal access with a good final outcome.

Meningioma of the cavernous sinus in a child: case report and review of the literature.

Meningiomas infrequently develop in children, and their clinical picture is somewhat different than in adults. We describe here a case of a meningioma in a 9-year-old girl unusual in two aspects. Firstly, it arose from the cavernous sinus what is exceptional in children. Secondly, despite the big tumor mass the child was almost asymptomatic. The only symptoms at presentation were a slight facial asymmetry and minimal laterodeviation of her mandible. Those symptoms had not been noticed by her parents and were detected during careful routine dental examination. The clinical course was quite aggressive and several neurosurgical interventions were necessary. This case underlines the importance of careful medical and dental examination during routine checkup consultations and undertaking necessary diagnostic procedures aimed at elucidating of all detected, even minimal abnormalities.

[Infusion test in the selection of patients with hydrocephalus for the shunting]. / Test infuzyjny w kwalifikacji chorych z wodoglowiem do zalozenia zastawki.

The indications for the shunting of the patients with NPH are a matter of discussion. The measurement of the outflow resistance during the infusion test is one of the criteria for shunting. The authors present 38 patients with NPH in whom the lumbar constant-infusion test was carried out. The patients with the outflow resistance more then 13 mmHg/ml/min were selected for shunting. The results at least 4 months after operation are presented.

[Management of patients with multiple intracranial aneurysms]. / Leczenie pacjentów z mnogimi tetniakami mózgu.

A retrospective analysis of 142 patients with multiple intracranial aneurysms operated on within eight years (1991-1998) was undertaken. In 82 patients multiple aneurysms were clipped during one procedure in the remaining 60 patients operation was performed in two stages. The clinical state of patients according to Hunt-Hess scale at the admission to the department was assessed, as well as the presence of blood on the initial CT scan according to Fisher scale and outcome according to Glasgow Outcome Scale. The operative results patients with multiple intracranial aneurysms are worse, than those with single aneurysm, which is connected with the necessity of wider exposure of cerebral vessels and possibility of bleeding from unclipped aneurysm, when operation is performed in two stages.

[Familial occurrence of hemangioblastoma]. / Rodzinne wystepowanie naczyniaka plodowego.

Haemangioblastoma is a benign vascular neoplasm accounting for approximately 1-2% of all intracranial tumours. Patients with haemangioblastoma are aged usually about 40 years, the tumour is situated mostly in the cerebellum, more frequently in males. The tumour is a component of the Hippel-Lindau syndrome with familial-hereditary dominant aetiology, often associated with retinal angiomatosis, cysts of the pancreas and kidneys, renal carcinoma and phaeochromocytoma. A familial haemangioblastoma is reported in father and son. The father had the tumour in cerebellar vermis but the son had multiple tumours in cerebellum and medulla.