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.

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.

Brain MRI-findings in Ph - negative myeloproliferative disorders

2019 ◽  
Vol 91 (7) ◽  
pp. 29-34 ◽  
Author(s):  
M M Tanashyan ◽  
A L Melikyan ◽  
P I Kuznetsova ◽  
A A Raskurazhev ◽  
A A Shabalina ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Sinus Thrombosis ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Myeloproliferative Disorders ◽  
Cerebral Venous Sinus Thrombosis ◽  
Mri Findings ◽  
Cerebral Lesions ◽  
Cerebrovascular Pathology ◽  
Underlying Mechanisms

Myeloproliferative disorders (MPD) are accompanied by a high proportion of thrombotic complications, which may lead to cerebrovascular disease (CVD). Aim. To describe MRI-findings in patients with Ph - negative MPD and evaluate any cerebrovascular disease. Materials and methods. We included 104 patients with Ph - negative MPD (age varied between 20 and 58) with clinical correlates of cerebrovascular pathology. Results. Brain MRI showed post - stroke lesions in 20% of patients (7 hemispheric infarcts due to thrombotic occlusion of one of the large cerebral arteries, 14 - cortical infarcts). 37 patients (36%) had vascular cerebral lesions. Cerebral venous sinus thrombosis occurred in 5 patients - in 7% (n=3) of patients with polycythemia vera and 5% (n=2) - in patients with essential thrombocythemia. The incidence of vascular cerebral lesions was associated with higher levels of the following: erythrocyte, platelet count, fibrinogen, and with the decrease in fibrinolytic activity, as well. Conclusion. The pioneering results of the study include the description and analysis of brain MRI-findings in patients with Ph - negative MPD. The underlying mechanisms of cerebrovascular pathology in these patients are associated with certain blood alterations (particularly, hemorheology) which present a major risk factor.

scholarly journals P.005 Lisdexamfetamine precipitated pathological gambling

2018 ◽  
Vol 45 (s2) ◽  
pp. S17-S17 ◽  
Author(s):  
F Chaudhary ◽  
A Hirsch ◽  
W MacPherson ◽  
J Nayati
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Nucleus Accumbens ◽  
Pathological Gambling ◽  
Risk Taking ◽  
Gambling Behavior ◽  
Hyperactivity Disorder ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
History Of ◽  
Mental Status Examination

Background: Lisdexamfetamine has not heretofore been reported to cause pathological gambling. Such a case is presented. Methods: A middle-aged woman, without past interest in gambling, gaming, or risk taking behavior, with childhood history of attention deficit hyperactivity disorder presented with difficulty focusing and concentrating. Lisdexamfetamine was started at 20 mg daily and gradually escalated due to lack of efficacy. At 70 mg daily, she began binging on sweets and gambling all day, every day at nearby riverboats, which she had never frequented previously. Upon reduction to 60 mg daily, the gambling resolved. Ritalin 20 mg every morning and 50 mg every afternoon was used without gambling reoccurrence. Results: Mental Status Examination: Alert, cooperative and oriented x 3 with good eye contact. Euthymic, without mania, thoughts logical and goal directed. Conclusions: Enhanced dopamine in the nucleus accumbens may induce hedonic activities including gambling, binging on sweets, or sexual activity (Moore et al. 2014). Lisdexamfetamine has been described to induce mania, and pathological gambling may have been an isolated manifestation of early mania. In those who have recently begun lisdexamfetamine, query should be made regarding change in gambling behavior and in those who are pathologically gambling, investigation should be entertained as to whether they are taking lisdexamfetamine.

Intracranial meningioma in a patient with osteogenesis imperfecta

Open Medicine ◽  
2008 ◽  
Vol 3 (4) ◽  
pp. 517-520
Author(s):  
Parmenion Tsitsopoulos ◽  
Ioannis Anagnostopoulos ◽  
Vasileios Tsitouras ◽  
Ioannis Venizelos ◽  
Philippos Tsitsopoulos
Keyword(s):  
Osteogenesis Imperfecta ◽  
Muscle Power ◽  
Brain Mri ◽  
Intracranial Meningioma ◽  
Type I ◽  
Mri Scans ◽  
Heritable Disorder ◽  
History Of ◽  
One Year ◽  
Gait Disturbances

AbstractOsteogenesis imperfecta (OI) is a heritable disorder characterized mainly by connective tissue manifestations. In dinstinct cases, several neurological features have also been described. A 46-year-old male with a known family history of OI type I presented with progressive gait disturbances and diminished muscle strength. Brain MRI scans revealed an infiltrative intracranial mass occupying both frontoparietal lobes. The patient underwent surgical intervention. The histological diagnosis was an atypical (Grade II) meningioma. The bony parts demonstrated a mixture of osseous defects due to OI and infiltration by the tumor. At one-year follow up the patient′s muscle power partially returned while repeat MRI scans were negative for tumor recurrence.

scholarly journals Miliary tuberculosis in a paediatric patient with psoriasis

2021 ◽  
Vol 14 (3) ◽  
pp. e237580
Author(s):  
Jacob Kilgore ◽  
Jonathon Pelletier ◽  
Bradford Becken ◽  
Stephen Kenny ◽  
Samrat Das ◽  
...  
Keyword(s):  
Brain Mri ◽  
Miliary Tuberculosis ◽  
Pulmonary Nodules ◽  
Chronically Ill ◽  
Community Acquired Pneumonia ◽  
Oral Antibiotic ◽  
Cavitary Lesion ◽  
Oral Antibiotic Therapy ◽  
History Of ◽  
Chest X Ray

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.

Abstract 36: Association of Parental Stroke with Cognitive and Brain MRI Measures in Offspring - The Framingham Heart Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
GALIT WEINSTEIN ◽  
Alexa Beiser ◽  
Rhoda Au ◽  
Charles DeCarli ◽  
Philip A Wolf ◽  
...  
Keyword(s):  
Executive Function ◽  
Brain Injury ◽  
Verbal Learning ◽  
Brain Mri ◽  
Abstract Reasoning ◽  
Parental History ◽  
Brain Volumes ◽  
Regional Brain ◽  
Increased Risk ◽  
History Of

Objectives- Parental stroke is related to an increased risk of stroke among the offspring. Vascular related brain changes, however, often occur before clinical stroke and the association of parental history of stroke and structural brain measures and cognition has not been fully explored. We hypothesized that prospectively verified parental stroke will be associated with increased vascular brain injury and poorer cognitive performance. Methods- A total of 1,297 Framingham offspring (mean age: 61 ± 9 years, 54% women) were studied. Of these, 9.9% had prospectively identified stroke in one or both parents before age 65. Volumetric brain MRI measures of total cerebral brain volume (TCBV), regional brain volumes, white matter hyperintensity volume (WMHV), and covert brain infarcts (CBI) and performance on tests of verbal memory, abstract reasoning, verbal learning and visuospatial memory (VRd) were compared for offspring with and without parental history of stroke. All measures were assessed cross-sectionally and longitudinally (mean duration of follow-up was 6.1±1.2 years). We used models adjusted only for age, sex, education and also additionally adjusted for vascular risk factors and for WMHV as an index of subclinical vascular brain injury. GEE models were used to adjust for sibling relationships among offspring. Results- Higher WMHV (β±SE=0.17±0.08;p=0.027) and lower VRd scores (β±SE=-0.80±0.34; p=0.017) at baseline were found in offspring with parental history of stroke. In addition, participants with parental stroke by age 65 years were more likely to be in the highest quintile of increase in WMHV (OR=1.87;p=0.04) as well as worsening executive function (Trails B-A) (OR:1.81;p=0.03). Parental stroke was not associated with total and regional brain volumes or with memory, abstract reasoning and verbal learning. Conclusions- In our community-based sample of middle-aged asymptomatic subjects, the occurrence of parental stroke by age 65 years is associated with higher baseline WMHV and with a more rapid increase in WMHV. Further, parental stroke is also associated with poorer performance on VRd and a decline in executive function. The effects on baseline WMH and VRd were substantial equivalent to 2.8 and 7 years of brain aging, respectively.

Abstract WP190: Clinical Features of Sarcoid Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ahmed Z Obeidat ◽  
Heidi Sucharew ◽  
Charles J Moomaw ◽  
Dawn O Kleindorfer ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Current Knowledge ◽  
Case Reports ◽  
Brain Mri ◽  
Sporadic Case ◽  
Prior History ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Stroke Event ◽  
History Of

Background: Current knowledge on ischemic stroke in sarcoid patients stems from sporadic case reports. The mechanism is thought to be related to granulomatous involvement of brain vasculature. However, clinical, demographic, and radiographic features of sarcoid patients with ischemic stroke are lacking. If sarcoid patients are at higher risk for ischemic stroke event, we hypothesized that the risk factors for ischemic stroke and stroke subtype distribution would differ between sarcoid and non-sarcoid ischemic stroke patients. Methods: Cases of ischemic stroke were identified for the years 2005 and 2010 from the population-based Greater Cincinnati/Northern Kentucky Stroke Study (population 1.3 million). Ischemic stroke cases were physician study confirmed and patients with a history of sarcoid were identified through medical chart review. Clinical variables were compared between stroke patients with history of sarcoid and those with no prior sarcoid history. Results: A total of 4258 cases of ischemic stroke were identified; of them, only 18 had prior diagnosis of sarcoid (0.04%). Brain MRI showed diffusion restriction in 14 out of 15 (93%) MRIs performed in sarcoid patients. The table presents risk factor and subtype data on sarcoid patients compared with non-sarcoid patients. Conclusions: We identified only a few cases of prior sarcoid history in our two-year ascertainment of ischemic stroke patients in our population. In comparison with stroke patients with no prior history of sarcoid, the sarcoid patients tended to be of younger age at presentation, female, have a history of diabetes and hyperlipidemia, and more likely of African descent, perhaps related to the diagnosis of sarcoid itself. We were unable to detect differences in stroke subtype distributions between sarcoid and non-sarcoid ischemic stroke patients.

Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

2021 ◽  
Author(s):  
Neelu Desai ◽  
Rahul Badheka ◽  
Nitin Shah ◽  
Vrajesh Udani
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

scholarly journals Laparoscopic resection of bilateral perinephric pseudocyst in a pediatric feline patient

2019 ◽  
Vol 5 (1) ◽  
pp. 205511691985064
Author(s):  
Margaret Amparo Placer ◽  
Cindy McManis
Keyword(s):  
Laparoscopic Resection ◽  
Kidney Injury ◽  
Abdominal Distension ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Invasive Approach ◽  
Less Invasive Approach ◽  
History Of ◽  
Grade 3

Case summary A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively. Relevance and novel information Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.

Sign in / Sign up

Export Citation Format

Share Document