scholarly journals Retrobulbar neuritis associated with empty sella syndrome: A diagnostic challenge

2021 ◽  
Vol 7 (3) ◽  
pp. 602-604
Author(s):  
Abhishek Agarwal ◽  
Manisha Kataria
Keyword(s):  
Vision Loss ◽  
Sella Turcica ◽  
Empty Sella ◽  
Diagnostic Challenge ◽  
Significant Past Medical History ◽  
Empty Sella Syndrome ◽  
Retrobulbar Neuritis ◽  
Acute Visual Loss ◽  
Finger Counting ◽  
Intravenous Steroids

A 35-year-old female presented with sudden diminution of vision to finger counting at half meters in right eye (RE) since 15 days. RE showed grade III RAPD. Rest of the ocular examination was normal. She had no significant past medical history. Neuroimaging showed empty sella. We suspected retrobulbar neuritis (RBN) as a cause of loss of vision since there was no evidence of acute change in morphology of sella turcica like hemorrhage, trauma or ischemia, furthermore there were no pathological findings in RE and visual cortex to explain acute visual loss. Therefore, we prescribed intravenous steroids followed by oral steroids. Vision in RE improved to 6/12 after 15 days. We found that RBN can be a cause of sudden vision loss in cases with empty sella syndrome (ESS) and can pose diagnostic challenge that whether the vision loss is due to ESS or RBN. RBN can be a cause of acute vision loss in patients with ESS and can create diagnostic confusion.

scholarly journals Benign Intracranial Hypertension: A Diagnostic Dilemma

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Gary Y. Shaw ◽  
Stephanie K. Million
Keyword(s):  
Intracranial Hypertension ◽  
Signs And Symptoms ◽  
Pseudotumor Cerebri ◽  
Empty Sella ◽  
Definitive Diagnosis ◽  
Benign Intracranial Hypertension ◽  
Imaging Studies ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Empty Sella Syndrome

Benign intracranial hypertension (BIH) (also known as pseudotumor cerebri and empty sella syndrome) remains a diagnostic challenge to most physicians. The modified Dandy criteria consist of, the classic findings of headache, pulsatile tinnitus, papilledema, and elevated cerebrospinal fluid (CSF) pressure, however, these are rarely collectively present in any one patient. Furthermore, these findings can wax and wane over time. Due to the nature of this disease, both signs and symptoms may be intermittent, making definitive diagnosis difficult. Newer imaging studies, particularly the magnetic resonance venogram (MRV) along with a constellation of correlative findings and associated diseases have given new impetus in the diagnosis, treatment, and pathophysiology of this disease. This has led the authors to offer modifications to the classic Dandy criteria. This report presents three representative cases of BIH highlighting many of the newer advances in both diagnosis and treatment of this perplexing disorder.

scholarly journals Spontaneous improvement of secondary empty sella syndrome due to re-expansion of an intrasellar cyst: A case report

2020 ◽  
Vol 11 ◽  
pp. 282
Author(s):  
Shodai Yamada ◽  
Kenji Yagi ◽  
Kazuhiro Hirano ◽  
Masaaki Uno
Keyword(s):  
Optic Nerve ◽  
Mr Imaging ◽  
Sella Turcica ◽  
Visual Disturbance ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
First Case ◽  
Spontaneous Improvement ◽  
The Right ◽  
Gyrus Rectus

Background: In patients with secondary empty sella syndrome (ESS), optic nerve herniation into the sella turcica is caused by shrinkage of the mass lesion at the sella turcica, resulting in visual disturbance. ESS is often surgically treated using chiasmapexy. Here, we report the first case of spontaneous improvement in a patient with ESS. Case Description: A 69-year-old woman presented with a month-long history of visual disturbance in the right eye, poor visual acuity, and quadrantanopia in her upper temporal visual field. Magnetic resonance (MR) imaging showed herniation of her right optic nerve and gyrus rectus into the sella turcica. The visual disturbance gradually improved, and the patient’s vision became almost normal after a month without any treatment. On repeated MR imaging, it was observed that the herniation of the right optic nerve and gyrus rectus disappeared due to an intrasellar cyst re-expansion. The secondary ESS caused by the shrinkage of the intrasellar cyst resulted in the visual disturbance and re-expansion of the cyst resulted in spontaneous improvement of symptoms. The visual disturbance did not recur for a year. Conclusion: Patients with secondary ESS without severe symptoms may be followed up conservatively. However, surgical treatment should be applied if symptoms deteriorate or do not improve.

Osseous Remodeling Technique of the Sella Turcica: A New Surgical Option for Primary Empty Sella Syndrome

2019 ◽  
Vol 126 ◽  
pp. e953-e958
Author(s):  
Gerardo Guinto ◽  
Barbara Nettel ◽  
Eli Hernández ◽  
David Gallardo ◽  
Norma Aréchiga ◽  
...  
Keyword(s):  
Sella Turcica ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Surgical Option ◽  
Primary Empty Sella

Spontaneous Nasal Cerebrospinal Fluid Leaks and Empty Sella Syndrome: A Clinical Association

2003 ◽  
Vol 17 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Sella Turcica ◽  
Empty Sella ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Empty Sella Syndrome ◽  
Csf Pressure ◽  
Csf Leaks

Background Spontaneous, idiopathic nasal meningoencephaloceles are herniations of arachnoid/dura and cerebrospinal fluid (CSF) through anatomically fragile sites within the skull base. Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF and giving the radiographic appearance of an absent pituitary gland. The objective of this study was to examine the association between spontaneous encephaloceles/CSF leaks and empty sella syndrome because of their similar clinical features and potential common pathophysiology. Methods Retrospective. Results Sixteen patients were treated for spontaneous encephaloceles between 1996 and 2001. All 16 patients had associated CSF leaks. Five patients had multiple simultaneous encephaloceles. Fifteen patients with imaging of the sella turcica had empty (10 patients) or partially empty (5 patients) sellas. One patient did not have complete imaging of the sella. Three patients had lumbar punctures with measurement of CSF pressure during computed tomography cisternograms because of multiple skull base defects. Mean CSF pressure was 28.3 cm of water (range, 19–34 cm; normal, 0–15 cm). Thirteen of 16 patients (81%) were obese women (mean body mass index, 35.9 kg/m2; normal, <25 kg/m2). Mean follow-up was 14.2 months with 100% success in closure of the defects after one procedure. Conclusion Spontaneous meningoencephaloceles and CSF leaks are strongly associated with radiographic findings of an empty sella and suggest a common pathophysiology. The underlying condition probably represents a form of intracranial hypertension that exerts hydrostatic pressure at anatomically weakened sites within the skull base. Otolaryngologists should be familiar with this disease entity and the implications intracranial hypertension has on patient management.

Primary hypothyroidism associated with empty sella turcica and hypopituitarism

2005 ◽  
Vol 58 (7-8) ◽  
pp. 410-413 ◽  
Author(s):  
Maja Milosevic ◽  
Milos Stojanovic ◽  
Milica Nesovic
Keyword(s):  
Sella Turcica ◽  
Pituitary Hormones ◽  
Empty Sella ◽  
Primary Hypothyroidism ◽  
Pituitary Hormone ◽  
Pituitary Insufficiency ◽  
Central Hypothyroidism ◽  
Empty Sella Syndrome ◽  
The Third ◽  
High Level

Introduction Empty sella syndrome is a rather frequent neuroradiological finding in the general population and can be associated with hypopituitarism. Examinations reveal low pituitary hormone levels and lack of response to stimuli. Most patients suffer from central hypothyroidism as part of pituitary insufficiency. Primary hypothyreoidism is a rare finding in these patients. Case report We present 3 patients: one female and two male, suffering from complete hypopituitarism, as part of the empty sella syndrome diagnosed due to low concentrations of all pituitary hormones, elevated TSH and low thyroid hormones. TRH, LHRH, ACTH and ITT tests, as well as IGF1 have confirmed hypopituitarism and primary hypothyroidism. CT and NMR in all three patients showed empty sella without a tumor in it. The diagnosis of primary hypothyrodism in the first patient was made before hypopituitarism has taken place, or at the same time in the second patient, whereas in the third patient it was diagnosed twenty years later. In two patients anti-TPO and anti-Tg antibody levels were high, and in the third patient they were not elevated. It can be assumed that the etiology of primary hypothyrodism in all three patients was of autoimmune origin, which caused thyroid hypofunction. High level of TSH in all three patients and especially in the patient whose hypopituitarism was diagnosed twenty years later, showed presence of thyrotrophic cells in the pituitary. Evaluation of the hypothalamic-pituitary-thyroid axis was carried out during the complete substitution therapy of hypopituitarism. Conclusion Diagnosing primary hypothyrodism associated with hypopituitarism helps improving the knowledge on empty sella syndrome and points to different clinical syndromes characterized by lack of mixoedema, although approach to therapy is the same for both primary and central hypothyroidism.

AYURVEDIC MANAGEMENT OF PARTIAL EMPTY SELLA SYNDROME: A CASE REPORT

2021 ◽  
Vol 12 (4) ◽  
pp. 15-18
Author(s):  
Eswara M P Sarma ◽  
Arathi P K
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Pituitary Gland ◽  
Sella Turcica ◽  
Marked Change ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Lukewarm Water

Empty Sella Syndrome is a disorder that involves the presence of Cerebro-spinal fluid in Sella turcica in an excess amount. In empty Sella syndrome the Sella turcica is either partially filled with cerebrospinal fluid and an atrophied pituitary gland lying in the floor of the Sella (Partial Empty Sella Syndrome) or filled with cerebrospinal fluid which pushes the pituitary gland into a side of Sella turcica resulting in non-visualization of the gland. (Completely empty Sella). A 37-year-old female diagnosed with partial empty Sella syndrome was managed with Pathyakshadhatryadi kashayam 15 ml twice daily in empty stomach with 45 ml lukewarm water, Rasnadi choornam tailam application, mahatraiphala ghritam 10 ml at night after food, Kshirabala 7 Avarti tailam pratimarsha nasyam. After completion of the treatment, there was considerable relief in the primary complaint of the patient which was a recurrent headache and the follow up MRI showed a marked change in the condition. This case report highlights the role of Ayurveda in the management of partial empty Sella syndrome and sheds light for further study on the same.

Cysts of the sella turcica

1970 ◽  
Vol 33 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Emil Lee Weber ◽  
F. Stephen Vogel ◽  
Guy L. Odom
Keyword(s):  
Clinical Course ◽  
Sella Turcica ◽  
Empty Sella ◽  
Epithelial Lining ◽  
Histological Findings ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Diagnostic Characteristics ◽  
Relationship Of ◽  
Fine Print

✓ In three patients intrasellar cysts were found without epithelial lining but containing thick dark brown fluid. The clinical course and histological findings suggested intermittent hemorrhage and infarction of the adenohypophysis as the probable etiology. The surgical importance of differentiating these lesions from cystic craniopharyngiomas and pituitary adenomas has been stressed in a discussion of the diagnostic characteristics. Wide surgical drainage is recommended as the treatment of choice. Evidence points to a possible relationship of these cysts to the “empty sella syndrome.”

A dynamic pressure study of spontaneous CSF rhinorrhea in the empty sella syndrome

1980 ◽  
Vol 52 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Stephen Davis ◽  
Andrew H. Kaye
Keyword(s):  
Cerebrospinal Fluid ◽  
Dynamic Pressure ◽  
Sella Turcica ◽  
Empty Sella ◽  
Icp Monitoring ◽  
Csf Rhinorrhea ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Shunt Procedure ◽  
Fine Print

✓ The authors report a case of cerebrospinal fluid (CSF) rhinorrhea in a patient with the empty sella syndrome in whom continuous intracranial pressure (ICP) monitoring revealed intermittent peaks of raised ICP. Following a shunt procedure, ICP reverted to normal and the CSF rhinorrhea ceased for 10 weeks. The sella turcica was packed with muscle after the CSF rhinorrhea recurred.

scholarly journals Utility of MRI in diagnosis of empty Sella syndrome in a young female with amenorrhoea and bilateral nipple discharge

2017 ◽  
Vol 5 (8) ◽  
pp. 3734
Author(s):  
Pokhraj P. Suthar ◽  
Gaurav R. Parmar ◽  
Chinmay Trivedi ◽  
Hemen I. Vithlani
Keyword(s):  
Rare Disease ◽  
Nipple Discharge ◽  
Sella Turcica ◽  
Young Female ◽  
Empty Sella ◽  
Empty Sella Syndrome

Empty sella syndrome is a rare disease in which sella turcica appears empty. It can be asymptomatic or may have symptoms due to hormonal disturbances. Here we report a case of 35-years-old female who presented with amenorrhoea and bilateral nipple discharge. 

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