Clinical versus Subclinical Pituitary Apoplexy: Presentation, Surgical Management, and Outcome in 21 Patients

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 980-986 ◽  
Author(s):  
Stephen T. Onesti ◽  
Thomas Wisniewski ◽  
Kalmon D. Post
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pituitary Apoplexy ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Computed Tomographic ◽  
Sellar Tumor

Abstract A retrospective review of 16 consecutive patients with pituitary apoplexy treated over a 10-year period is reported. Eight men and 8 women (mean age, 48 years) underwent transsphenoidal decompression after an average duration of symptoms of 19 days. The diagnosis of pituitary apoplexy was made by the sudden onset of headache (88%), nausea (56%), or meningismus (13%), with or without visual disturbances (75%), in the setting of a sellar tumor on computed tomographic or magnetic resonance imaging scans. Thirteen of 16 patients showed significant improvement of symptoms after surgery (average follow-up, 2.5 years). In addition, 5 patients with clinically silent yet extensive pituitary hemorrhage were treated. Although extensive pituitary hemorrhage often produced fulminant apoplexy, it also presented insidiously over many days with few, if any, clinical signs. Rapid diagnosis, endocrine replacement, and transsphenoidal decompression constituted effective therapy. Magnetic resonance imaging (after at least 12 hours of symptoms) was superior to computed tomography in detecting hemorrhage.

Subacute Pituitary Apoplexy: Clinical and Magnetic Resonance Imaging Characteristics

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Roberta P. Glick ◽  
James A. Tiesi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Resonance Imaging ◽  
Mri Scan ◽  
Imaging Characteristics ◽  
Invaluable Tool ◽  
Magnetic Resonance Imaging Mri

Abstract Between 1987 and 1988, we utilized magnetic resonance imaging (MRI) in the diagnosis of seven cases of “subacute” pituitary apoplexy. that is, intra-adenomatous pituitary hemorrhage associated with clinical symptoms atypical of acute pituitary apoplexy. These symptoms lasted longer than 24 hours and included visual changes in four patients, headache in five, and seizures, endocrine dysfunction, and oculomotor palsy in one each. Estimates of the ages of the hemorrhages were also possible based on characteristics on the MRI scan and ranged from 48 hours to more than 14 days. Four of our seven patients underwent transsphenoidal decompression at which time the presence of intratumoral hemorrhage was confirmed. The remaining three patients have been followed as outpatients with serial MRI examinations and have shown improvement in clinical symptoms and stabilization of the radiological picture. From our series of patients, it is now apparent that the MRI scan is an invaluable tool in identifying this subacute form of intra-adenomatous pituitary hemorrhage and has proven especially useful as a means of therapeutic planning and follow-up care in patients presenting with symptoms not typical of classic pituitary apoplexy.

Progressive Myelopathy Due to a Spontaneous Intramedullary Hematoma in a Dog: Pre- and Postoperative Clinical and Magnetic Resonance Imaging Follow-up

2008 ◽  
Vol 44 (5) ◽  
pp. 266-275 ◽  
Author(s):  
Jean-Laurent Thibaud ◽  
Antoine Hidalgo ◽  
Ghita Benchekroun ◽  
Laurent Fanchon ◽  
Francois Crespeau ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neurological Examination ◽  
Clinical Signs ◽  
Resonance Imaging ◽  
Surgical Scar ◽  
Progressive Myelopathy ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

A 4-year-old, male Jack Russell terrier was presented for a 6-month history of progressive right hemiparesis with episodic cervical hyperesthesia. The neurological examination showed a right-sided, upper motoneuron syndrome and partial Horner’s syndrome. Two magnetic resonance imaging (MRI) examinations were performed 3 months apart and revealed a persistent cervical intramedullary hematoma. A dorsal myelotomy was performed. A subacute hematoma was confirmed histologically without underlying lesions. Eighteen months later, the dog’s clinical signs were minimal. Two MRI examinations were performed 2 weeks and 5 months after surgery and revealed regressing signal abnormalities at the surgical site, consistent with a surgical scar.

Supratentorial Convexity Leptomeningeal Schwannoma: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1295-1298 ◽  
Author(s):  
Keiko Nakayama ◽  
Tetsuo Nakayama ◽  
Yoshimi Matsuoka ◽  
Kinuko Kono
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Cranial Nerves ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Pia Mater ◽  
Left Frontal Lobe ◽  
Computed Tomographic ◽  
Rare Location

Abstract OBJECTIVE AND IMPORTANCE Leptomeningeal schwannomas are very rare; to our knowledge, only one case has been previously reported. The possible histogenesis and differential diagnosis of intracranial schwannomas not related to cranial nerves are discussed. CLINICAL PRESENTATION A 53-year-old man presented with a sudden onset of seizures. Computed tomographic scans revealed a small hypodense mass in the peripheral aspect of the left frontal lobe. The mass was hypointense on T1-weighted and hyperintense on T2-weighted magnetic resonance imaging scans, with ring enhancement after contrast medium administration. INTERVENTION A craniotomy was performed for total removal of the tumor, revealing a well-demarcated, firm, spherical tumor beneath the dura. The tumor was easily separated from the brain. Histologically, the tumor was observed to be within the subarachnoid space, intimately attached to the pia mater. The adjacent brain tissue and dura mater were free of tumor cells. The histological diagnosis was schwannoma. CONCLUSION Computed tomographic and magnetic resonance imaging findings in our case were consistent with those for a schwannoma, although the subarachnoid space is an extremely rare location for schwannomas. We emphasize that schwannomas may arise in the subarachnoid space.

Chordoma and Chondrosarcoma of the Cranial Base: An 8-Year Experience

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 931-941 ◽  
Author(s):  
Chandra Nath Sen ◽  
Laligam N. Sekhar ◽  
Victor L. Schramm ◽  
Ivo P. Janecka
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cranial Base ◽  
Low Grade ◽  
Resonance Imaging ◽  
Total Removal ◽  
Postoperative Radiation Therapy ◽  
Computed Tomographic

Abstract Between 1980 and 1988, 8 patients with chordomas and 9 with low-grade chondrosarcomas involving the cranial base were treated. All the patients were investigated preoperatively and postoperatively with computed tomographic or magnetic resonance imaging scans, according to a standard protocol. The tumors and the involved bony structures were surgically removed in one or more operations using different operative approaches. Ten patients underwent postoperative radiation therapy, either at our institution or prior to their referral to us. Total removal was defined as the absence of identifiable tumor on magnetic resonance imaging or computed tomographic obtained 3 months postoperatively, and was accomplished in 9 patients. The ability to achieve total removal was greatly increased in patients with tumors that had not previously been operated on. We believe that these tumors must be treated by aggressive surgical resection when initially diagnosed, and this can be accomplished with low morbidity. The follow-up period in our patients was too short to allow us to determine whether such total removals can result in a cure or in long-term control of these formidable tumors.

scholarly journals Changes of Dorsal Root Ganglion Volume in Dogs with Clinical Signs of Degenerative Myelopathy Detected by Water-Excitation Magnetic Resonance Imaging

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1702
Author(s):  
Eiji Naito ◽  
Kohei Nakata ◽  
Yukiko Nakano ◽  
Yuta Nozue ◽  
Shintaro Kimura ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Clinical Signs ◽  
Intervertebral Disc Herniation ◽  
Resonance Imaging ◽  
Diagnostic Potential ◽  
Water Excitation ◽  
Spinal Cord Segment ◽  
Degenerative Myelopathy

Canine degenerative myelopathy (DM) is a progressive and fatal neurodegenerative disease. However, a definitive diagnosis of DM can only be achieved by postmortem histopathological examination of the spinal cord. The purpose of this study was to investigate whether the volumetry of DRG using the ability of water-excitation magnetic resonance imaging (MRI) to visualize the DRG in dogs has premortem diagnostic value for DM. Eight dogs with DM, twenty-four dogs with intervertebral disc herniation (IVDH), and eight control dogs were scanned using a 3.0-tesla MRI system, and water-excitation images were obtained to visualize and measure the volume of DRG, normalized by body surface area. The normalized mean DRG volume between each spinal cord segment and mean volume of all DRG between T8 and L2 in the DM group was significantly lower than that in the control and the IVDH groups (P = 0.011, P = 0.002, respectively). There were no correlations within the normalized mean DRG volume between DM stage 1 and stage 4 (rs = 0.312, P = 0.128, respectively). In conclusion, DRG volumetry by the water-excitation MRI provides a non-invasive and quantitative assessment of neurodegeneration in DRG and may have diagnostic potential for DM.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

Sign in / Sign up

Export Citation Format

Share Document