Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series

2021 ◽  
Author(s):  
Mohammed Alahmari ◽  
Fahad Alkherayf ◽  
Andrea Lasso ◽  
Fatmahalzahra Banaz ◽  
Sepideh Mohajeri ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Case Series ◽  
Surgical Decompression ◽  
Tumor Type ◽  
Visual Deficit ◽  
Nerve Recovery ◽  
Sixth Nerve

Abstract Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification. Design Present study is a single-institution retrospective cohort. Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery. Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.

scholarly journals P.156 Outcomes of Cranial Nerve Deficits in Patients with Pituitary Apoplexy: The Ottawa Hospital Experience

2021 ◽  
Vol 48 (s3) ◽  
pp. S64-S64
Author(s):  
M Alahmari ◽  
S Kilty ◽  
A Lasso ◽  
F Banaz ◽  
S Mohajeri ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Visual Fields ◽  
Case Series ◽  
Tumor Type ◽  
Endoscopic Endonasal ◽  
Third Nerve Palsy ◽  
Visual Deficit ◽  
Small Series

Background: One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following endoscopic endonasal transsphenoidal surgery (EETS). Methods: Retrospective cohort study with patient characteristics, tumor type, endocrine data, operation data collected. Postoperative data were extracted for the follow-up period available for each patient. Results: 15 pituitary apoplexy cases were identified. The cranial nerve deficits presented at admission were: visual deficit (33% patients); unilateral third nerve palsy (47% patients), unilateral sixth nerve palsy (27% patients). Postoperatively, 60% of patients with preoperative visual deficit had normal visual fields and the other 40% showed improvement. From those with oculomotor nerve dysfunction preoperatively, 43% have returned to normal nerve function and 57% presented improvement. 75% cases of abducens nerve palsy resolved postoperatively, while 25% showed improvement. Conclusions: Based on this series, surgical treatment should be offered to patients presenting with cranial nerve deficit in the setting of pituitary apoplexy. In this series, all cranial nerve deficits either returned to normal or improved following surgery. Though a small series, the presented results are superior to those reported in the literature for conservative management.

Medial rectus disinsertion for management of chronic complete sixth nerve palsy

2021 ◽  
pp. 112067212110652
Author(s):  
Abbas Bagheri ◽  
Amirreza Veisi ◽  
Mehdi Tavakoli
Keyword(s):  
Nerve Palsy ◽  
Case Series ◽  
Medial Rectus ◽  
Retrospective Case ◽  
Primary Position ◽  
Sixth Nerve Palsy ◽  
Prism Dioptre ◽  
Abnormal Head ◽  
Sixth Nerve

Purpose To report the outcomes of the medial rectus (MR) disinsertion procedure for the management of refractory esotropia (ET) with or without Abnormal head posture (AHP) in chronic complete sixth nerve palsy. Methods This is a retrospective case series of patients with sixth nerve palsy who suffered from residual ET and diplopia following the conventional strabismus surgeries and underwent MR disinsertion procedure between April 2017 and February 2020. This procedure was offered to the patients who declined to use prism and did not wish to perform surgery on the fellow eye. The demographic and clinical data, including sex, age, visual acuity, pre and postoperative angle of strabismus, duction limitations, results of forced duction and force generation tests, details of prior strabismus surgeries, orbital CT scan findings, and follow up duration were collected from the medical records. Results Six patients were enrolled in this study. Mean age was 35.0  ±  14.0 years, and mean follow-up was 15.3  ±  5.9 months. The ET at the Primary position (PP) was 35.0  ±  18.4 prism dioptre (PD) before MR disinsertion, which decreased to 14.2  ±  17.4 PD after MR disinsertion procedure. Four cases needed additional complementary surgeries to improve residual ET in PP. No case developed overcorrection. Abduction deficiency was −5.0  ±  1.3 before MR disinsertion, which improved to − 2.8  ±  0.5 units at last follow-up. The mean of induced adduction deficiency was − 2.9  ±  0.4 at last follow-up. Conclusions MR disinsertion can be considered in patients with chronic complete sixth nerve palsy and refractory diplopia when the conventional methods have failed.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

Surgery option in the management of delayed diplopia after radiation therapy for nasopharyngeal carcinoma

2018 ◽  
Vol 28 (5) ◽  
pp. 547-551
Author(s):  
Leilei Zou ◽  
Sujia Wu ◽  
Yan Liu ◽  
Shu Wang ◽  
Wen Wen ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Case Series ◽  
Topical Anesthesia ◽  
Lateral Rectus ◽  
Prism Diopter ◽  
Retrospective Case ◽  
Patient Reported ◽  
Sixth Nerve

Purpose: Radiation therapy is a standard treatment for nasopharyngeal carcinoma. Diplopia due to radiation damage to the sixth nerve significantly erodes the patient’s quality of life. This study investigated the effectiveness of extraocular surgery in the treatment of delayed diplopia caused by radiation therapy. Methods: A retrospective case series of 16 patients (7 men and 9 women) with delayed diplopia after radiation therapy for nasopharyngeal carcinoma was enrolled in the study. Unilateral lateral rectus resection was performed under topical anesthesia. Follow-up time was more than 12 months. Outcome measures were prism diopter and self-reported symptoms. Results: All patients diagnosed with sixth nerve palsy reported elimination of symptoms on postoperative day 1 without complications. One patient required a second procedure due to recurrence of symptoms. At 12-month follow-up, no patient reported recurrence of symptoms. The absolute horizontal deviation significantly decreased from a preoperative value of 16 prism diopter to a value of 1.5 prism diopter postoperatively (p < 0.001). Conclusion: These results suggest that unilateral lateral rectus resection under topical anesthesia is an effective treatment for delayed diplopia after radiation therapy for nasopharyngeal carcinoma. A large randomized prospective study to confirm these findings is warranted.

scholarly journals Intracavernous Internal Carotid Artery Aneurysm Presenting as Acute Diplopia: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 362-365
Author(s):  
Austin Brown ◽  
Health Jolliff ◽  
Douglas Poe ◽  
Michael Weinstock
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Sixth Nerve

Introduction: Diplopia is an uncommon emergency department (ED) complaint representing only 0.1% of visits, but it has a large differential. One cause is a cranial nerve palsy, which may be from a benign or life-threatening process. Case Report: A 69-year-old female presented to the ED with two days of diplopia and dizziness. The physical exam revealed a sixth cranial nerve palsy isolated to the left eye. Imaging demonstrated an intracavernous internal carotid artery aneurysm. The patient was treated with embolization by neurointerventional radiology. Discussion: The evaluation of diplopia is initially divided into monocular, usually from a lens problem, or binocular, indicating an extraocular process. Microangiopathic disease is the most common cause of sixth nerve palsy; however, more serious etiologies may be present, such as an intracavernous internal carotid artery aneurysm, as in the patient described. Imaging modalities may include computed tomography or magnetic resonance imaging. Conclusion: Some causes of sixth nerve palsy are benign, while others will require more urgent attention, such as consideration of an intracavernous internal carotid artery aneurysm.

scholarly journals Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

2021 ◽  
pp. 1-4
Author(s):  
Pierre Decavel ◽  
Olympe Nahmias ◽  
Carine Petit ◽  
Laurent Tatu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prone Position ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
University Hospital ◽  
Cranial Neuropathy ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

<b><i>Introduction:</i></b> A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. <b><i>Results:</i></b> Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. <b><i>Conclusion:</i></b> The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

scholarly journals Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

2018 ◽  
Vol 76 (6) ◽  
pp. 373-380 ◽  
Author(s):  
Conrado Regis Borges ◽  
Sérgio Monteiro de Almeida ◽  
Karen Sue ◽  
Jéssyca Luana Alves Koslyk ◽  
Mario Teruo Sato ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Univariate Analysis ◽  
White Blood Cells ◽  
Case Series ◽  
Transverse Myelitis ◽  
Retrospective Case ◽  
Ocular Syphilis

ABSTRACT Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient’s myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

Radiosurgical Management of Benign Cavernous Sinus Tumors: Dose Profiles and Acute Complications

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 1022-1032 ◽  
Author(s):  
Joseph C.T. Chen ◽  
Steven L. Giannotta ◽  
Cheng Yu ◽  
Zbigniew Petrovich ◽  
Michael L. Levy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pituitary Adenoma ◽  
Radiation Dose ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Tumor Volume ◽  
Grade Iii

Abstract OBJECTIVE Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife. METHODS From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions. The tumor type distribution was 29 pituitary adenomas, 35 meningiomas, 4 schwannomas, and 1 paraganglioma. The median follow-up was 122 weeks. Lesions were stratified according to a five-level surgical grade. The grade distribution of the tumors was as follows: Grade I, 13; Grade II, 21; Grade III, 19; Grade IV, 12; Grade V, 4. Median tumor volume was 4.7 cm3. The median radiation dose was 15 Gy to the 50% isodose line. Median maximal radiation dose was 30 Gy. RESULTS Analysis of tumor characteristics and radiation dose to optic nerve and pontine structures revealed a significant correlation between distance and dose. Much lower correlation coefficients were found between tumor volume and dose. One lesion in this series had evidence of transient progression and later regression on follow-up radiographic studies. No other lesions in this series were demonstrated to have exhibited progression. Complications after radiosurgical treatment were uncommon. Two patients had cranial nerve deficits after treatment. One patient with a surgical Grade III pituitary adenoma had VIth cranial nerve palsy 25 months after radiosurgical treatment that spontaneously resolved 10 months later. A patient with a bilateral pituitary adenoma experienced bilateral VIth cranial nerve palsy 3 months after treatment that had not resolved at 35 months after treatment. Six patients with preoperative cranial nerve deficits experienced resolution or improvement of their deficits after treatment. One patient with a prolactin-secreting adenoma experienced normalization of endocrine function with return of menses. CONCLUSION Radiosurgical treatment represents an important advance in the management of cavernous sinus tumors, with low risk of neurological deficit in comparison with open surgical treatment, even in patients with high surgical grades.

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