scholarly journals 1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Tan ◽  
A Zammit

Abstract Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.

1970 ◽  
Vol 14 (1) ◽  
pp. 9-14
Author(s):  
Sudhangshu Shekhar Biswas ◽  
Zaheer Al-Amin

Necrotizing Fasciitis of head -neck is not so uncommon in diabetic patients which is a progressive, destructive and potentially life threatening soft tissue infection primarily affecting superficial fascial planes. It is caused by group A streptococci or by a synergistic combination of aerobe and anaerobe micro organisms. This is a retrospective study which makes an attempt to analyze various parameters such as demography, aetiology, complications, and management methods determining the overall prognosis. Odontogenic infection was the primary source of infection. Diabetes, anaemia, chronic renal failure and electrolyte imbalance were the most commonly associated illness. Surgical debridement with combined antibiotic therapy was used in the management of necrotizing fasciitis along with good control of diabetes and correction of anaemia and electrolyte imbalances. Overall mortality was low. The late referral and associated complications had increased the hospital stay. With proper control of infection by early diagnosis, surgical debridement and combined antibiotic therapy, along with timely control of complications and associated illness - better results can be possible. Key words: necrotizing fasciitis, antibiotics, debridement  DOI: 10.3329/bjo.v14i1.3274 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 9-14


Author(s):  
Derick Adams ◽  
Philip A Kern

Summary Pituitary abscess is a relatively uncommon cause of pituitary hormone deficiencies and/or a suprasellar mass. Risk factors for pituitary abscess include prior surgery, irradiation and/or pathology of the suprasellar region as well as underlying infections. We present the case of a 22-year-old female presenting with a spontaneous pituitary abscess in the absence of risk factors described previously. Her initial presentation included headache, bitemporal hemianopia, polyuria, polydipsia and amenorrhoea. Magnetic resonance imaging (MRI) of her pituitary showed a suprasellar mass. As the patient did not have any risk factors for pituitary abscess or symptoms of infection, the diagnosis was not suspected preoperatively. She underwent transsphenoidal resection and purulent material was seen intraoperatively. Culture of the surgical specimen showed two species of alpha hemolytic Streptococcus, Staphylococcus capitis and Prevotella melaninogenica. Urine and blood cultures, dental radiographs and transthoracic echocardiogram failed to show any source of infection that could have caused the pituitary abscess. The patient was treated with 6weeks of oral metronidazole and intravenous vancomycin. After 6weeks of transsphenoidal resection and just after completion of antibiotic therapy, her headache and bitemporal hemianopsia resolved. However, nocturia and polydipsia from central diabetes insipidus and amenorrhoea from hypogonadotrophic hypogonadism persisted. Learning points Pituitary abscesses typically develop in patients who have other sources of infection or disruption of the normal suprasellar anatomy by either surgery, irradiation or pre-existing pathology; however, they can develop in the absence of known risk factors. Patients with pituitary abscesses typically complain of headache, visual changes and symptoms of pituitary hormone deficiencies. As other pituitary neoplasms present with similar clinical findings, the diagnosis of pituitary abscess is often not suspected until transsphenoidal resection is performed. Prompt surgical and medical treatment of pituitary abscess is necessary, which typically results in improvement in headache and visual changes; however, pituitary hormone deficiencies are typically often permanent.


2020 ◽  
Vol 133 (5) ◽  
pp. 1355-1359
Author(s):  
Maria Peris-Celda ◽  
Laura Salgado-Lopez ◽  
Carrie Y. Inwards ◽  
Aditya Raghunathan ◽  
Carrie M. Carr ◽  
...  

Benign notochordal cell tumors (BNCTs) are considered to be benign intraosseous lesions of notochord origin; however, recent spine studies have suggested the possibility that some chordomas arise from BNCTs. Here, the authors describe two cases demonstrating histological features of BNCT and concomitant chordoma involving the clivus, which, to the best of the authors’ knowledge, have not been previously documented at this anatomical site.An 18-year-old female presented with an incidentally discovered clival mass. Magnetic resonance imaging revealed a 2.8-cm nonenhancing lesion in the upper clivus that was T2 hyperintense and T1 hypointense. She underwent an uneventful endoscopic transsphenoidal resection. Histologically, the tumor demonstrated areas of classic chordoma and a distinct intraosseous BNCT component. The patient completed adjuvant radiation therapy. Follow-up showed no recurrence at 18 months.A 39-year-old male presented with an incidentally discovered 2.8-cm clival lesion. The nonenhancing mass was T2 hyperintense and T1 hypointense. Surgical removal of the lesion was performed through an endoscopic transsphenoidal approach. Histological analysis revealed areas of BNCT with typical features of chordoma. Follow-up did not demonstrate recurrence at 4 years.These cases document histologically concomitant BNCT and chordoma involving the clivus, suggesting that the BNCT component may be a precursor of chordoma.


2007 ◽  
Vol 73 (7) ◽  
pp. 684-687 ◽  
Author(s):  
Eric T. Castaldo ◽  
Edmund Y. Yang

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.


Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1080
Author(s):  
Hanna Yolanda ◽  
Theerapong Krajaejun

The fungus-like microorganism Pythium insidiosum causes pythiosis, a life-threatening infectious disease increasingly reported worldwide. Antimicrobial drugs are ineffective. Radical surgery is an essential treatment. Pythiosis can resume post-surgically. Immunotherapy using P. insidiosum antigens (PIA) has emerged as an alternative treatment. This review aims at providing up-to-date information of the immunotherapeutic PIA, with the focus on its history, preparation, clinical application, outcome, mechanism, and recent advances, in order to promote the proper use and future development of this treatment modality. P. insidiosum crude extract is the primary source of immunotherapeutic antigens. Based on 967 documented human and animal (mainly horses) pythiosis cases, PIA immunotherapy reduced disease morbidity and mortality. Concerning clinical outcomes, 19.4% of PIA-immunized human patients succumbed to vascular pythiosis instead of 41.0% in unimmunized cases. PIA immunotherapy may not provide an advantage in a local P. insidiosum infection of the eye. Both PIA-immunized and unimmunized horses with pythiosis showed a similar survival rate of ~70%; however, demands for surgical intervention were much lesser in the immunized cases (22.8% vs. 75.2%). The proposed PIA action involves switching the non-protective T-helper-2 to protective T-helper-1 mediated immunity. By exploring the available P. insidiosum genome data, synthetic peptides, recombinant proteins, and nucleic acids are potential sources of the immunotherapeutic antigens worth investigating. The PIA therapeutic property needs improvement for a better prognosis of pythiosis patients.


2020 ◽  
Vol 18 (2) ◽  
pp. 98-104
Author(s):  
M. Mitev ◽  
L. Pekova ◽  
St. Valkanov

Infections of the nervous system and its belonging structures have often been reported as life-threatening conditions. Purpose: the results of dynamic follow-up and proving of changes in secondary meningoencephalitis from suppurative left maxillary sinusitis are presented using the imaging methods - CT and MRI. Methods: diagnostic imaging (CT, MRI), of acute disease in a 13-year-old child with progressive development and proving of secondary bacterial meningoencephalitis. Result: the control CT after two days showed dynamics in the imaging CT finding with the appearance of changes in the type of brain oedema and development of pansinusitis. The MRI data described corresponded to changes as at meningoencephalitis in progress.Conclusion: The extension of the diagnostic algorithm with MRI, with the administration of intravenous contrast medium, clearly demonstrated changes characteristic of meningoencephalitis.


2015 ◽  
Vol 44 (2) ◽  
pp. 181
Author(s):  
Maja Bogdan ◽  
Vlasta Zujić Atalić ◽  
Ivan Hećimović ◽  
Dubravka Vuković

<p><strong>Objective</strong>. The aim of this report was to describe the occurrence of a bacterial brain abscess in a healthy individual, without any predisposing condition. <strong>Case report</strong>. A thirteen-year old boy was admitted to the Department of Neurosurgery after the onset of vomiting, headache and dizziness. A neurological deficit was detected during the physical examination so urgent magnetic resonance imaging of the brain was performed, revealing an intrahemispheric, right positioned solitary expansive mass with ring enhancement. Purulent material was obtained during osteoplastic craniotomy with total extirpation of the brain abscess. Aggregatibacter aphrophilus and Bacteroides uniformis were isolated. The patient’s general condition improved and the neurological deficit subsided as a result of the prompt recognition and treatment of this life threatening condition. <strong>Conclusion</strong>. To achieve a favourable clinical outcome, prompt recognition and surgical treatment of a brain abscess are of primary importance,followed by administration of appropriate antimicrobial therapy. To our best knowledge, this is the first report of this combination of microorganisms as the cause of a brain abscess.</p>


1930 ◽  
Vol 3 (1) ◽  
pp. 51-64 ◽  
Author(s):  
A. G. Lochhead ◽  
Leone Farrell

Examination of soil from different locations, extending over a twelve-month period, for the presence of sugar-tolerant yeasts capable of fermenting honey, showed that only in the case of apiary ground was the soil regularly infected by such organisms. Ordinary field soil is not to be considered a primary source of infection of honey, sugar-tolerant yeasts not being regarded as members of the normal soil microflora. Sugar-tolerant yeasts, in apiary soils, are able to remain viable through the winter in frozen soil, but are cold-enduring rather than psychrophilic. From the soil 166 cultures of sugar-tolerant yeasts were isolated and classified. These were found to represent seven types considered as six species with one sub-species, three being types found in fermented honey. A description of the yeasts is given.


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