scholarly journals Pituitary apoplexy causing acute ischemic stroke: Which treatment should be given priority

2020 ◽  
Vol 11 ◽  
pp. 113 ◽  
Author(s):  
Jae-Min Ahn ◽  
Hyuk-Jin Oh ◽  
Jae-Sang Oh ◽  
Seok-Mann Yoon
Keyword(s):  
Pituitary Adenoma ◽  
Cerebral Ischemia ◽  
Pituitary Apoplexy ◽  
Rare Complication ◽  
Sudden Onset ◽  
Pituitary Macroadenoma ◽  
Conventional Angiography ◽  
Pituitary Dysfunction ◽  
Acute Cerebral Ischemia

Background: Pituitary apoplexy is syndrome of sudden onset of headache, visual loss, pituitary dysfunction, and altered consciousness. Pituitary apoplexy followed by acute cerebral ischemia is extremely rare. Here, we introduced the case of successful surgical resection of pituitary adenoma which induced acute cerebral ischemia. Case Description: A 78-year-old man with a known pituitary macroadenoma presented with decreased consciousness and left hemiparesis. Magnetic resonance image (MRI) and computed tomography (CT) showed large pituitary macroadenoma with hemorrhage and diffusion-perfusion mismatch of right internal carotid artery (ICA) territory. Conventional angiography was done and severe stenosis of bilateral ICA and prominent flow delay of left ICA were noted at paraclinoid segment. Microscopic tumor mass removal with transsphenoidal approach was performed. Final pathological diagnosis was pituitary adenoma with apoplexy. Immediately after surgery, his symptoms were disappeared. Follow-up image studies revealed much improved perfusion in right ICA territory and patency of bilateral ICAs. Conclusion: Direct compression of ICA is rare complication of pituitary apoplexy, which caused cerebral ischemia. Conventional angiography should be necessary for accurate diagnosis and prompt surgical decompression should be the treatment of choice.

scholarly journals Pituitary apoplexy following endoscopic nasal surgery: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1985586
Author(s):  
Teemu Harju ◽  
Juha Alanko ◽  
Jura Numminen
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Pituitary Macroadenoma ◽  
Nasal Surgery ◽  
Resonance Imaging ◽  
Acute Haemorrhage ◽  
Endoscopic Nasal Surgery ◽  
Precipitating Factor ◽  
Field Defects

Pituitary apoplexy develops as a consequence of acute haemorrhage and/or infarction in a pre-existing pituitary adenoma. Typical symptoms include sudden onset headache, visual acuity/field defects, and ocular palsies. We report a male patient with a known pituitary macroadenoma who underwent a right-sided endoscopic nasal surgery. Preoperatively, thickening of sphenoid mucosa was seen in computed tomography and magnetic resonance imaging. The patient developed pituitary apoplexy postoperatively. The presented report indicates that in patients with a pituitary adenoma, nasal surgery – like any other kind of surgery – is a possible precipitating factor for pituitary apoplexy. Isolated thickening of sphenoid mucosa is associated with pituitary apoplexy. It may also precede an apoplectic event.

scholarly journals Pituitary Adenoma with Apoplexy with Arteriovenous Malformation

2017 ◽  
Vol 06 (01) ◽  
pp. 059-061
Author(s):  
Rajeev Bansal ◽  
Jitendra Shekhawat ◽  
Devendra Purohit
Keyword(s):  
Pituitary Adenoma ◽  
Arteriovenous Malformation ◽  
Pituitary Apoplexy ◽  
Single Case ◽  
Mass Effect ◽  
Sudden Onset ◽  
Sudden Loss ◽  
Rare Association ◽  
Chief Complaints

Background This is a rare association of pituitary adenoma with apoplexy with arteriovenous malformation as only single case was reported prior to this case as per our knowledge. Case Description A 25-year-old man presented with chief complaints of headache of sudden onset, severe in intensity with sudden loss of vision. Imaging shows pituitary adenoma with apoplexy with right parietal arteriovenous malformation. The patient was managed with embolization for parietal arteriovenous malformation and medically for pituitary adenoma with apoplexy. Conclusion Pituitary apoplexy can be treated conservatively if no features of mass effect present. Follow-up of the patient must be done regularly to look for the size of pituitary adenoma and recurrence of arteriovenous malformation.

scholarly journals An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

2016 ◽  
Vol 4 (1) ◽  
pp. 21
Author(s):  
Yanerys Agosto Vargas ◽  
Sharon Velez Maymi ◽  
Paola Mansilla Letelier ◽  
Luis Raul Hernandez-Vazquez ◽  
Samayra Miranda Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Mortality Rate ◽  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Systemic Hypertension ◽  
Pituitary Macroadenoma ◽  
Rare Entity ◽  
Factors Associated ◽  
Multiple Risk Factors

Pituitary apoplexy secondary to sellar tumors is a rare entity that carries a high mortality rate. It could be secondary to infarction or hemorrhage of the pituitary gland. The incidence remains unclear, most are reported in men between the ages of 50 to 60. In the majority of times, apoplexy is idiopathic in nature, without a clear discernible cause. However, there are multiple risk factors associated with this entity, such as systemic hypertension, among others. There are few cases of pituitary apoplexy caused by infarction of a pituitary macroadenoma. We present this case of pituitary apoplexy secondary to infarction of a nonfunctional pituitary adenoma in a young woman, with a fortunate resolution.

Relevance of supraventricular runs detected after cerebral ischemia

Neurology ◽  
2017 ◽  
Vol 89 (15) ◽  
pp. 1545-1552 ◽  
Author(s):  
Mark Weber-Krüger ◽  
Constanze Lutz ◽  
Antonia Zapf ◽  
Raoul Stahrenberg ◽  
Joachim Seegers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cerebral Ischemia ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Acute Cerebral Ischemia ◽  
Temporal Phenomenon ◽  
Long Term Follow Up ◽  
Recurrent Strokes

Objective:Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up.Methods:Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence.Results:A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent).Conclusions:Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.

scholarly journals Metastasis of a Dorsal Melanoma to a Pituitary Adenoma Mimicking Pituitary Apoplexy

2017 ◽  
Vol 36 (04) ◽  
pp. 238-242
Author(s):  
Rui Ramos ◽  
Maria Machado ◽  
Cristiano Antunes ◽  
Vera Fernandes ◽  
Olinda Marques ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pituitary Adenoma ◽  
Adjuvant Radiotherapy ◽  
Transsphenoidal Surgery ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Macroadenoma ◽  
Histology Result ◽  
History Of ◽  
Transcranial Approach

AbstractMetastases to pituitary adenomas are very rare. From the 20 cases found in the literature, none originated from a cutaneous melanoma. We present the case of a 67-year-old man with a history of transcranial approach to treat a pituitary macroadenoma followed by adjuvant radiotherapy. Fifteen years later, he presented a dorsal nodular melanoma, and three years after that, he developed symptoms of pituitary apoplexy. He was submitted to transsphenoidal surgery, and the histology result revealed metastasis of the melanoma into a pituitary adenoma.The similarity in the clinical presentation of the two entities—pituitary apoplexy and metastasis of the melanoma into a pituitary adenoma—and the rarity of this type of metastization alert to challenges in the differential diagnosis that may confound the neurosurgeon's decision.

scholarly journals A case of pituitary apoplexy following posterior lumbar fusion surgery

2015 ◽  
Vol 23 (5) ◽  
pp. 598-601 ◽  
Author(s):  
Akın Akakın ◽  
Baran Yılmaz ◽  
Murat Şakir Ekşi ◽  
Türker Kılıç
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Lumbar Fusion ◽  
Rare Complication ◽  
Interdisciplinary Approach ◽  
Electrolyte Imbalance ◽  
Fusion Surgery ◽  
Posterior Lumbar Fusion ◽  
Lumbar Fusion Surgery ◽  
First Case

Pituitary adenoma is a common primary brain neoplasm. Pituitary apoplexy (PA) is a rare complication of pituitary adenoma and occurs as the result of sudden tumor growth and following different comorbidities. The authors describe the first case of PA following posterior lumbar fusion surgery performed while the patient was prone. In patients with a preexisting pituitary adenoma, thorough clinical and laboratory investigations should be conducted using an interdisciplinary approach before any planned surgery. In unknown cases of pituitary adenoma, PA should be kept in mind for the differential diagnosis in a case with headache, nausea, vomiting, ophthalmoplegia, visual loss, and electrolyte imbalance concurrent with an ongoing disease state.

Increasing Levels of Leukocyte-Derived Inflammatory Mediators in Plasma and cAMP in Platelets during Follow-Up after Acute Cerebral Ischemia

1998 ◽  
Vol 8 (6) ◽  
pp. 310-317 ◽  
Author(s):  
I. Anwaar ◽  
A. Gottsäter ◽  
K. Ohlsson ◽  
I. Mattiasson ◽  
F. Lindgärde
Keyword(s):  
Cerebral Ischemia ◽  
Inflammatory Mediators ◽  
Acute Cerebral Ischemia

Pituitary Apoplexy: A Rare Cause of Cerebral Infarction

2008 ◽  
Vol 21 (5) ◽  
pp. 661-665 ◽  
Author(s):  
A. Ben-Nakhi ◽  
T.J.E. Muttikkal ◽  
V.N.K. Chavan ◽  
A. Yt Al-Turkomani ◽  
R. Gupta
Keyword(s):  
Pituitary Adenoma ◽  
Cerebral Ischemia ◽  
Sudden Death ◽  
Cerebral Infarction ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Mass Effect ◽  
Mechanical Obstruction ◽  
Hemorrhagic Infarction

Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.

scholarly journals Rare complication of subacute renal artery intramural haematoma after renal artery stenting: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Yang Chen ◽  
Hui Dong ◽  
Xiongjing Jiang ◽  
Wuqiang Che
Keyword(s):  
Renal Artery ◽  
Stent Implantation ◽  
Rare Complication ◽  
Final Diagnosis ◽  
Transluminal Angioplasty ◽  
Sudden Onset ◽  
Intramural Haematoma ◽  
Luminal Narrowing ◽  
Artery Obstruction

Abstract Background Renal artery intramural haematoma (IMH) is a rare cause of renal artery obstruction after stenting. Diagnosis and treatment are difficult as there are only a few cases reported. Case summary We present the case of sudden-onset abdominal pain and non-functional kidney 3 days after renal artery stent implantation. Subacute luminal narrowing of the renal artery was initially diagnosed using computed tomography angiography and renal artery angiography, and a final diagnosis of subacute renal artery IMH was made using intravascular ultrasound (IVUS). Subsequently, the patient was treated with percutaneous transluminal angioplasty from far to near and another stent implantation. At the third month follow-up, blood pressure and renal function were normal. Discussion This case suggests that IVUS could be useful for qualifying and treating the subacute renal artery IMH.

scholarly journals SAT-273 Case of Mistaken Identity?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carlos Pla
Keyword(s):  
Muscle Weakness ◽  
Pituitary Adenomas ◽  
Complete Resolution ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Pituitary Macroadenoma ◽  
Patient Reported ◽  
Work Up

Abstract Introduction Pituitary adenomas occur in 10-15% of patients and the majority are benign. Prolactinomas are the most common form of secretory pituitary adenoma. Pituitary apoplexy, a medical emergency with resulting visual loss and hormonal hyposecretion, requires rapid surgical intervention. We present a case of pituitary macroadenoma that underwent pituitary resection for acute visual disturbance which was later discovered to be caused by undiagnosed demyelinating disease. Clinical Case Patient is a 32-year-old male who presented initially with complain of fatigue and decreased libido. Work up revealed elevated prolactin level and low testosterone. MRI showed a 2x3cm pituitary macroadenoma. At moment of diagnosis, patient was otherwise asymptomatic. He was started on bromocriptine. During follow up visits, patient reported visual disturbance. First MRI in our clinic showed no suprasellar extension, no impingement of optic chiasm and nonspecific white matter disease. At that time, visual field testing showed left temporal defect in superior quadrant. Follow up MRI 1 year later continued to show a stable macroadenoma without impingement of the optic chiasm, but patient reported progressive left vision disturbance and new right vision loss. He was evaluated in the emergency room where he was treated for pituitary apoplexy with steroids and surgery. Vision improved the next day. Despite uncomplicated post-operative course, patient developed proximal muscle weakness and exam notable for diffuse motor deficit in bilateral lower extremities with hyperreflexia. Endocrinology workup was negative for hypercortisolism and ophthalmology diagnosed him with optic neuropathy. Neurology evaluation led to a diagnosis of multiple sclerosis (MS). Patient was started on natalizumab with complete resolution of all visual and muscle symptoms. Clinical lesson Our patient presented with complaints of fatigue, decreased libido and work up that showed a macroprolactinoma without MRI evidence of optic chiasm impingement. During treatment, he developed acute visual deficits that were attributed to pituitary apoplexy. This visual disturbance improved after surgery and use of high dose IV steroids, with the latter likely treating what had been an MS flare. In hindsight, ophthalmologic evaluation before surgery had shown new color blindness, a sign of optic neuropathy. Despite temporary relief, patient progressed to develop new muscle weakness and recurrent visual disturbance which led to the diagnosis of MS. Since being diagnosed and treated for MS, he has had complete resolution of his symptoms. This case stresses the importance of considering other etiologies for visual defects in patients with pituitary adenomas.

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