scholarly journals A Rare Association between Myasthenia Gravis and a Growth Hormone Secreting Pituitary Macroadenoma: A Single Case Report

2019 ◽  
Vol 2019 (7) ◽  
Author(s):  
M T Farfouti ◽  
M Ghabally ◽  
G Roumieh ◽  
S Farou ◽  
M Shakkour
Keyword(s):  
Myasthenia Gravis ◽  
Single Case ◽  
Brain Mri ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Pituitary Mass ◽  
Myasthenic Patient ◽  
Single Case Report ◽  
History Of ◽  
Underlying Causes

Abstract Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disease. Although it is well known that patients with myasthenia gravis have a higher incidence of other autoimmune disorders, however, its association with pituitary adenomas is extremely rare. We believe that our case represents the 8th of this association and the 2nd case involving a GH-secreting adenoma. Here we report a case of a 45-year old Syrian woman who presented with typical complaints of myasthenia gravis as she was suffering from variable painless and effort-related dysphagia and dysarthria. Her complaints became more evident at the end of the day, while acromegaly only manifested as a 4-month history of headache and a special facies that was noted by the physician. Brain MRI scan demonstrated a 3.21 x 2.42 x 2.35 cm pituitary mass for which the patient underwent a trans-sphenoidal pituitary tumor resection. In addition, postoperative histopathological investigations confirmed the diagnosis of a GH-secreting macroadenoma. On following up, it was observed that her myasthenic symptoms improved significantly on Pyridostigmin and Prednisolone. In conclusion, the presence of headache in a myasthenic patient should raise the attention for other underlying causes including pituitary tumors.

scholarly journals Obstructive Hydrocephalus, Fifth Nerve and Hypothalamus Involvement: Acute Presentation of a Giant Prolactinoma

2012 ◽  
Vol 5 ◽  
pp. CCRep.S9675 ◽  
Author(s):  
Shadin Alkatari ◽  
Naji Aljohani
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Pituitary Tumors ◽  
Resonance Imaging ◽  
Pituitary Mass ◽  
Giant Prolactinoma ◽  
History Of ◽  
Proper Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Lactotrope Cells

Introduction Pituitary tumors from lactotrope cells account for about 40% of all functioning pituitary cancers. Men tend to present with a larger, more invasive and rapid growth prolactinomas than women, possibly because hypogonadism features are less evident. Case report A 27-year-old, previously asymptomatic Saudi man presented with a 3-day history of emesis with severe left-sided frontal headache, left face and right upper limb numbness, with signs of obstructive hydrocephalus. Brain Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a giant pituitary mass occupying several regions (sellar, infra-sellar, and supra-sellar) measuring 6.5 × 5.7 × 5.9 cm, and invading the sphenoid sinus as well as the cavernous sinuses bilaterally, with intra-pituitary hemorrhage compressing the third ventricle causing obstructive hydrocephalus. Prolactin levels were> 200,000 mIU/L, consistent with invasive giant prolactinoma (IGP). He was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of IGP. Conclusion This is a rare case of obstructive hydrocephalus with super-imposed intra-pituitary hemorrhage secondary to IGP, highlighting the importance of a full hormonal assessment for proper diagnosis and management.

Henry R. Viets, MD, and the history of myasthenia gravis

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011239
Author(s):  
Robert M. Feibel
Keyword(s):  
Myasthenia Gravis ◽  
Medical School ◽  
History Of Medicine ◽  
Harvard Medical School ◽  
Massachusetts General Hospital ◽  
Great Success ◽  
Myasthenic Patient ◽  
History Of ◽  
Medical Historian

Henry R. Viets (1890–1969) was both a noted neurologist and medical historian. While at Harvard Medical School, from which he graduated in 1916, he attracted the attention of Harvey Cushing who directed Viets into these disciplines. Cushing arranged for Viets to take a fellowship in Oxford in the year after his graduation. With Cushing's recommendation, he lived with Sir William and Lady Osler and did research with the famous neurologist Sir Charles Sherrington. Viets was in London in 1935 when he heard about the remarkable success of Mary Walker in treating myasthenia gravis, first with physostigmine and then with neostigmine (Prostigmin). Securing an ampoule of this drug, he took it to the Massachusetts General Hospital where he was an attending neurologist and in March 1935 injected it into a myasthenic patient with great success. He established the first Myasthenia Gravis Clinic in the world and was a pioneer in the treatment of this once obscure disease: he evaluated hundreds of patients and published many articles on myasthenia. He continued this association for over 30 years. Under the tutelage of Cushing and Osler, Viets became a medical historian and bibliophile, publishing hundreds of articles and several books on many different subjects in the history of medicine. He was the President of the American Association for the History of Medicine and curator of the Boston Medical Library that eventually joined with the Harvard Medical School Library. Viets served on the Editorial Board of the New England Journal of Medicine for 40 years.

scholarly journals Natural history of the anterior visual pathway after surgical decompression in patients with pituitary tumors

2015 ◽  
Vol 42 (S1) ◽  
pp. S45-S45 ◽  
Author(s):  
RA Won Hyung ◽  
W Chan ◽  
Y Starreveld ◽  
F Costello
Keyword(s):  
Structural Changes ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Visual Pathway ◽  
Surgical Decompression ◽  
Fiber Layer ◽  
Nerve Fiber Layer Thickness ◽  
Compressive Neuropathy ◽  
History Of ◽  
Endoscopic Tumor Resection

Introduction: Visual dysfunction is one of the primary indications for surgical management of pituitary tumors with the goal of terminating the progressive decline in vision. Unfortunately, it is difficult to predict how successful surgical decompression will be in these patients. The purpose of this study was to assess the structural changes seen in the anterior visual pathway after pituitary tumor resection. Methods: 13 patients (7F) underwent endoscopic tumor resection for pituitary macroadenoma. Each patient underwent a full ophthalmologic assessment including optical coherence tomography (OCT) preoperatively and postoperatively at 3-6months and 9-12months. Post-surgical changes in the retinal nerve fiber layer thickness (RNFLT) for each eye (N=26) were compared in cases with normal preoperative RNFLT (greater than 80 μm) versus those with abnormally thinned RNFLT (less than 80 μm). Results: For 9 cases with thinned RNFLT preoperatively (mean=70.1 μm±8.5), there was a significant decline in RNFLT at 3-6 months follow-up (mean change= −3.8 μm;p=0.002), which did not recover even at 9-12months after surgery (mean=67.6 μm±12.7). Contrastingly, eyes with normal RNFLT preoperatively (mean=89.7 μm±9.4) did not show significant postoperative thinning (mean change= −1.9 μm). Conclusion: Even after a complete surgical decompression, there are ongoing structural changes in the anterior visual pathway in patients with compressive neuropathy. There may be a point of no return where surgical decompression may not prevent further structural degeneration.

scholarly journals DIPG-23. SINGLE CASE REPORT OF LOW DOSE RADIOTHERAPY AND CHEMOTHERAPY IN THE TREATMENT OF DIPG

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii291-iii291
Author(s):  
Chen Kan Tseng ◽  
I-Jun Chou
Keyword(s):  
Total Dose ◽  
Single Case ◽  
Obstructive Hydrocephalus ◽  
Brain Mri ◽  
Ataxic Gait ◽  
Surgical Biopsy ◽  
Usual Practice ◽  
Single Case Report ◽  
Pontine Lesion ◽  
T2 Hyperintensity

Abstract A 3 year-old girl, was noted to have progressive gait problem since Nov. 2017 and brought to hospital for checkup. Brain MRI on Jan. 2018 showed T2 hyperintensity infiltrative pontine lesion, favoring diffuse infiltrative pontine glioma and mild obstructive hydrocephalus, received VP-shunting on Jan. 15, 2018. Due to the refusal of surgical biopsy for tissue proof, we started the radiotherapy from Jan. 24, 2018, using Rapidarc technique with 6MV photon energy to treat the brain stem lesion, ended on Feb. 24, 2018 with total dose of 25.5Gy in 17 fractions as our usual practice. Following the completion of radiotherapy, we started the adjuvant chemotherapy using 1-week on, 1-week off regimen of temozolomide using dosage of 75 mg/sq-m/day, and this patient’s general condition returned back to nearly normal. Serial follow-up images of brain MRI on 04/30/2018, 08/01/2018, 11/30/2018, 02/26/2019, 05/30/2019, 08/28/2019 showed slow progression of the pontine lesion, without the development of contrast enhanced new lesion. She maintained the functional independent until Sep. 2019, she was noted to have symptoms of ataxic gait, esotropia and choking on drinking liquid. We started the retreatment of radiotherapy from Oct.7, 2019, using same technique, ended on Nov. 5, 2019 with total dose of 30Gy in 20 fractions. The symptoms improved partially after the treatment, with residual weakness over left extremity. We are still treating the patient with adjuvant temozolomide, and she has survived most of time functionally independent in these 2 years.

scholarly journals Management of Ardit w.s.r to Bell ’s palsy with Nasya and Ayurveda treatment protocol- A Single Case Report

2018 ◽  
Vol 2 (2) ◽  
pp. 35-38
Author(s):  
Neha Sharma
Keyword(s):  
Facial Paralysis ◽  
Single Case ◽  
Previous History ◽  
Treatment Protocol ◽  
Facial Movement ◽  
Recent Infection ◽  
Single Case Report ◽  
Patient Reported ◽  
Oral Steroids ◽  
History Of

A 36 year old female patient with two weeks history of right sided facial paralysis, presenting with inability to close right eye, which also had tearing and a burning sensation.In present time, due to fast life style, anxiety, stress etc., incidence of Vatavyadhi like Pakshaghata, Ardita etc is increasing. Aggravation of Vata is responsible to cause Ardita. On the basis of its origin and symptoms mentioned in Sushruta Samhita, Ardita can be correlated with facial paralysis or Bell’s palsy caused by involvement of VII cranial nerve.  The great Indian sage Caraka, in his medical tome scripted in the second century BC describes the aetiology and management of Ardita. Bearing this idea in mind Nasya karma with panaspatra sveda was selected in present case.  There was no previous history of similar symptoms or a recent infection. Prior treatment had included oral steroids. The patient perceived a 70% to 80% improvement of facial movement after the first treatment. After the second treatment, the patient reported full control of his facial movement.

scholarly journals Symptomatic hepatothorax presenting 25 years after penetrating thoracoabdominal injury

2021 ◽  
Vol 103 (1) ◽  
pp. e17-e19
Author(s):  
S Variawa ◽  
R Marais ◽  
JJP Buitendag ◽  
J Edge ◽  
E Steyn
Keyword(s):  
Single Case ◽  
Superior Vena ◽  
Treatment Options ◽  
Vena Cava ◽  
Clinical Signs ◽  
Mass Effect ◽  
Point Of Entry ◽  
Single Case Report ◽  
History Of ◽  
The Right

Hepatic herniation through the diaphragm is a rare finding. It generally occurs due to a congenital diaphragmatic abnormality or blunt trauma resulting in a diaphragmatic defect. Making the diagnosis is difficult, as there are few definitive clinical signs and chest radiograph (CXR) findings may be non-specific. To our knowledge, only a single case report exists of penetrating right diaphragm injury leading to hepatic herniation. A 42-year-old man presented to the emergency department of a regional hospital with hyperglycaemia and exertional dyspnoea. He was diagnosed with diabetes mellitus type 2. He gave a history of smoking for 15 pack-years, was negative for retroviral disease and had no history of pulmonary tuberculosis. He had no significant surgical history but reported being stabbed with a knife in 1995. The point of entry was below the level of the nipple in the right anterior axillary line. At the time, he was treated with an intercostal drain and discharged home. CXR showed a right-sided chest mass. We considered a differential diagnosis of pulmonary consolidation, diaphragm eventration or hepatothorax. Computerized tomography of the chest and abdomen demonstrated apparent intrathoracic extension of the right liver lobe and partial attenuation of the superior vena cava and right atrium due to a mass effect. The upper border of the liver abutted the aortic arch. Surgical treatment options were discussed. The patient declined surgery and will be followed up as an outpatient.

scholarly journals Trigemino-autonomic headache and Horner syndrome as a first sign of granulomatous hypophysitis

2017 ◽  
Vol 4 (3) ◽  
pp. e332 ◽  
Author(s):  
Jeremias Motte ◽  
Ilonka Kreitschmann-Andermahr ◽  
Anna Lena Fisse ◽  
Christian Börnke ◽  
Christoph Schroeder ◽  
...  
Keyword(s):  
Cerebral Arteries ◽  
Brain Mri ◽  
Duplex Ultrasound ◽  
Subtotal Resection ◽  
Pituitary Mass ◽  
Horner Syndrome ◽  
Granulomatous Hypophysitis ◽  
Aged Woman ◽  
Cerebral Mri ◽  
History Of

Objective:To report a rare case of incipient granulomatous hypophysitis presenting by atypical trigemino-autonomic cephalalgia (TAC) and Horner syndrome.Methods:The patient was investigated with repeated brain MRI, CSF examination, thoracic CT, Doppler and duplex ultrasound of the cerebral arteries, and extensive serologic screening for endocrine and autoimmune markers. Written informed consent was obtained from the patient for access to clinical files for research purposes and for publication.Results:We present a middle-aged woman with a history of an autoimmune pancreatitis type 2 who had therapy-refractory TAC with Horner syndrome. Initial cerebral MRI showed only indistinct and unspecific signs of a pathologic process. A biopsy revealed a granulomatous hypophysitis. The symptoms disappeared after transsphenoidal subtotal resection of the pituitary mass and anti-inflammatory therapy.Conclusions:This case elucidates that inflammatory pituitary diseases must be taken into account in case of atypical and refractory TAC, especially in patients with a history of autoimmune diseases. To our knowledge, the association between TAC accompanied by Horner syndrome and hypophysitis has not yet been described before.

Bipolar Affective Disorder Minus Left Prefrontal Cortex Equals Schizophrenia

1996 ◽  
Vol 168 (5) ◽  
pp. 647-650 ◽  
Author(s):  
Alfred Pang ◽  
Shôn W. Lewis
Keyword(s):  
Prefrontal Cortex ◽  
Affective Disorder ◽  
Past History ◽  
Single Case ◽  
Bipolar Affective Disorder ◽  
Specific Pattern ◽  
Left Temporal Lobe ◽  
Single Case Report ◽  
History Of ◽  
The Relationship

BackgroundAn investigation of the relationship between bipolar affective disorder and schizophrenia, following a severe head injury and removal of the left prefrontal cortex.MethodA single case report.ResultsAn individual with past history of bipolar affective disorder suffered traumatic damages to the left prefrontal cortex with a second lesion in the left temporal lobe. The patient developed typical schizophrenia nine months later. The relevance of his brain lesions in determining the schizophrenic symptoms is discussed.ConclusionWe propose that the specific pattern of brain injury in this patient was sufficient to change the phenotype from bipolar affective disorder to schizophrenia.

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