scholarly journals Giant Prolactinoma presenting with facial nerve palsy and hemiparesis

2021 ◽  
Author(s):  
Aleksandra Sliwinska ◽  
Fatima Jalil ◽  
Lori De La Portilla ◽  
Michael Baldwin ◽  
Joseph Lorenzo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Prolactin Level ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Sella Turcica ◽  
Neurological Deficits ◽  
Lower Extremity Weakness ◽  
Giant Prolactinoma ◽  
Giant Prolactinomas ◽  
The Brain

Abstract Background Giant prolactinomas are an exceedingly uncommon type of pituitary adenomas that usually occur in men, cause extremely high prolactin levels and mass related symptoms. Rarely, patients may experience neurological deficits resembling ischemic events. Methods We describe an unusual case of a young man who presented with stroke-like symptoms and was found to have a giant prolactinoma. Clinical Case 25-year-old man presented with the left facial droop and gradually progressing upper and lower extremity weakness for evaluation of stroke. He reported recent weight gain and erectile dysfunction. Physical exam revealed left homonymous hemianopsia, left VII nerve palsy, and left hemiparesis. MRI of the brain showed an enormous mass in the sella turcica, which invaded the sphenoid sinus and right side of the skull base. Prolactin level was elevated at 13580 ng/mL, and the testosterone level was low. The patient was started on cabergoline and had marked improvement in his symptoms in a few months. Fifteen months after starting treatment, he has had more than 90% reduction in tumor volume and a 93% reduction in prolactin level. Conclusion Giant prolactinomas are uncommon and present with compressive symptoms that can be mistaken for a stroke. Our case is a unique report of a facial nerve palsy and hemiparesis secondary to giant prolactinoma in the absence of stroke or pituitary apoplexy.

scholarly journals Child Neurology (Neurocritical Care/Neuro Trauma)

2015 ◽  
Vol 42 (S1) ◽  
pp. S24-S24
Author(s):  
JA Mailo ◽  
J Pugh ◽  
FD Jacob
Keyword(s):  
Bacterial Meningitis ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Neurological Deficits ◽  
Search Terms ◽  
History Of ◽  
Streptococcal Meningitis ◽  
The Brain ◽  
New Onset

Background: Focal neurological deficits occur in approximately 15% of children with bacterial meningitis. However, cranial nerve involvement such as facial-nerve palsy is uncommon in non-tuberculous bacterial meningitis. Methods: Case Report. Review of the literature was conducted on Pubmed for the search terms: facial nerve palsy and meningitis. Results: We present the case of a 4-year old right-handed girl who presented with a new onset unilateral facial nerve palsy preceded by 5-day history of fever and headaches. The patient had meningeal signs and was identified to have Streptococcal Meningitis. MRI of the brain showed a large previously undiagnosed intranasal encephalocele. The facial palsy resolved within 7 days of antibiotic treatment. Conclusions: Our case represents an unusual combination of facial nerve palsy in context of Streptococcal Meningitis secondary to intranasal encephalocele.

scholarly journals SUN-285 Too Big to Be True, Too Young to Stroke!

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fatima Jalil ◽  
Lori De La Portilla ◽  
Joseph Anthony Lorenzo ◽  
Faryal Sardar Mirza
Keyword(s):  
Erectile Dysfunction ◽  
Case Reports ◽  
Sella Turcica ◽  
Mass Effect ◽  
Lower Extremity Weakness ◽  
Stroke Treatment ◽  
Basal Nuclei ◽  
Giant Prolactinoma ◽  
First Line Therapy ◽  
Giant Prolactinomas

Abstract BACKGROUND: Lactotroph adenomas are the most common type of pituitary adenomas and can cause infertility and menstrual irregularities in women; hypogonadism and gynecomastia in men.1 Giant prolactinomas are an unusual subset of pituitary macroadenomas with limited literature available on their management.2 We describe an unusual case of giant prolactinoma in a young man who presented with symptoms of stroke, that reversed with treatment with cabergoline. Clinical Case: 25-year old man presented with gradually progressing upper extremity weakness for evaluation of stroke. He reported stumbling into things when walking. There was a question of left sided facial droop and Bell’s palsy in recent past. He reported recent weight gain and erectile dysfunction. He was noted to have left homonymous hemianopsia on exam in addition to left upper and lower extremity weakness. MRI Brain showed an enormous mass that filled the sella turcica, invaded the sphenoid sinus and right side of the skull base, invaginating deep into the base of the right cerebral hemisphere with mass effect on the pons, right-sided midbrain, right temporal lobe and right basal nuclei, measuring 6.3 X 5.5 x 7.5 cm. Pituitary hormonal evaluation showed elevated prolactin (PRL) level with dilution at 13,580 ng/mL, with low testosterone (T) level (total T 42 ng/dL, free T 10 pg/mL, SHBG 15 nmol/L). Thyroid and adrenal axes were intact with normal IGF-1 level. In view of very high PRL level, he was started on cabergoline 0.5 mg daily initially and decreased to every other day after 2 weeks as PRL level began to decline. In 8 months, PRL levels decreased to 1293.07 ng/dl (90% reduction) and prolactinoma decreased to 6.0 x 3.7 x 4.7 cm (56% volume reduction). Total and free T improved to 134 ng/dL and 31 pg/dL respectively. He experienced marked improvement in left hemianopsia, with resolution of weakness and slurred speech. Energy level and erectile dysfunction improved. Currently he is being maintained on 0.5 mg cabergoline every other day Conclusion: Giant prolactinomas are uncommon and can present with compressive symptoms, that can be mistaken as stroke. Treatment with anticoagulation may cause hemorrhage and apoplexy with worsening of symptoms.1,2 There is limited data available regarding first line therapy for giant prolactinomas with 2 case reports where giant prolactinomas have been treated effectively with cabergoline.3,4 It is important to recognize the cause of such symptoms, and treated where possible with effective medical therapy to prevent morbidity. References: 1. Moraes A et al., Giant prolactinomas: the therapeutic approach. Clin Endo (Oxf). 2013 Oct;79(4):447-56 2. Acharya SV et al., Giant prolactinoma and effectiveness of medical management. Endocr Pract. 2010 Feb;16(1):42-6 3. Ahmed, M, et al., Large Prolactinoma. NEJM 2010; 363:177 4. Masoud, R et al., Giant prolactinoma: case report. J Diabetes Metab Disord. 2013; 12: 3

scholarly journals Facial nerve palsy produced by plasma cell granuloma

1997 ◽  
Vol 2 (6) ◽  
pp. E8 ◽  
Author(s):  
Guillermo Rubio ◽  
C. Garciá Guijo ◽  
J. M. Baez
Keyword(s):  
Facial Nerve ◽  
Plasma Cell ◽  
Nerve Palsy ◽  
Plasma Cells ◽  
Facial Nerve Palsy ◽  
Healthy Person ◽  
Plasma Cell Granuloma ◽  
Peripheral Facial Nerve Palsy ◽  
Immunohistochemical Studies ◽  
The Brain

There are many causes for peripheral facial nerve palsy, such as an isolated phenomenon occurring in a healthy person (Bell's palsy), a manifestation of a systemic illness, or a component of a more widespread neurological disease. Plasma cell granuloma is the proliferation of polyclonal, nonneoplastic plasma cells. Several cases have been reported in the literature in which plasma cell granulomas have affected the brain, lungs, gastrointestinal tract, kidneys, salivary glands, and skin. We report a case of peripheral facial nerve palsy produced by a plasma cell granuloma that was confirmed by histological and immunohistochemical studies.

TRANSIENT FACIAL NERVE PALSY AFTER SCALP BLOCK FOR AWAKE CRANIOTOMY: A CASE REPORT

2018 ◽  
Vol 4 (5) ◽  
pp. 369-371
Author(s):  
Rajashree U Gandhe . ◽  
Chinmaya P Bhave . ◽  
Avinash S Kakde . ◽  
Neha T Gedam .
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Awake Craniotomy ◽  
Scalp Block

scholarly journals Facial nerve palsy as the presenting feature of metastatic prostatic cancer in the temporal bone

2020 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Daichi Fujii ◽  
Hikari Shimoda ◽  
Natsumi Uehara ◽  
Takeshi Fujita ◽  
Masanori Teshima ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Prostatic Cancer ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Metastatic Prostatic Cancer

scholarly journals HGG-48. ROS1 INHIBITOR ENTRECTINIB USE IN RELAPSE/REFRACTORY INFANTILE GLIOBLASTOMA WITH POSITIVE ROS1 FUSION - A CASE REPORT WITH PROMISING RESPONSE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii352-iii352
Author(s):  
Dennis Tak-Loi Ku ◽  
Matthew Ming-Kong Shing ◽  
Godfrey Chi-Fung Chan ◽  
Eric Fu ◽  
Ping-Wa Yau ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Tumour Progression ◽  
Molecular Study ◽  
Subtotal Resection ◽  
Residual Tumour ◽  
Molecular Assay ◽  
Debulking Surgery

Abstract INTRODUCTION Infantile glioblastoma is rare with poor prognosis. Recent molecular study for infantile hemispheric high grade glioma found its association with ALK/ROS1/NTRK/MET pathway. This suggested the potential use of targeted therapy for refractory / relapse patients. CASE: A newborn presented with apnea, CT brain showed intracranial haemorrhage. MRI then showed a left parietal tumour with bleeding and mass effect. Craniotomy achieved subtotal resection. Chemotherapy VCR/CPM alternating with CDDP/VP-16 was given for one year. Patient was stable with static residual tumour during chemotherapy. However patient developed status epilepticus two weeks after off treatment. MRI showed significant tumour progression which required 2nd & 3rd debulking surgery. Molecular assay by nanostring panel showed BRAF-KIAA1549 fusion. MEK inhibitor Trametinib was tried for 3 months and stopped as disease progression. Further molecular assay by RNASeq showed presence of ROS1 fusion (ZCCHC8-ROS1) while absent of BRAF fusion. Patient underwent 4th debulking surgery as impending herniation while waiting for the targeted therapy. It was complicated with right hemiplegia and facial nerve palsy postoperatively. Finally, ROS1 inhibitor Entrectinib was started 2 weeks later. It was well tolerated without significant adverse reaction. Patient made dramatic neurological recovery including improved facial nerve palsy, able to walk unaided and self feed. MRI brain 1 and 3 months after Entrectinib showed interval reduction in residual tumour. Patient is currently progression-free for 6 months. CONCLUSION Early molecular study for infantile glioblastoma is useful to guide novel therapy. Molecular result may varies between different panels or change over time, to be interpreted with caution.

scholarly journals A rare case of congenital facial nerve palsy with extreme ocular manifestations

2021 ◽  
Vol 14 (5) ◽  
pp. e242540
Author(s):  
Rahul Kumar Bafna ◽  
Suman Lata ◽  
Anusha Sachan ◽  
Mohamed Ibrahime Asif
Keyword(s):  
Facial Nerve ◽  
Rare Case ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Ocular Manifestations
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