Pituitary apoplexy associated with a triple bolus test

1984 ◽  
Vol 61 (3) ◽  
pp. 586-590 ◽  
Author(s):  
Mark Bernstein ◽  
Robert A. Hegele ◽  
Fred Gentili ◽  
Michael Brothers ◽  
Richard Holgate ◽  
...  

✓ The authors report a case of pituitary apoplexy resulting in bilateral internal carotid artery occlusion, with marked depression of consciousness and hemiplegia. After transsphenoidal tumor decompression, restoration of flow in both carotid arteries was documented angiographically and the patient made an excellent clinical recovery. The unique aspect of this case is that the pituitary apoplexy was apparently precipitated by neuroendocrine manipulation, performed as a preoperative test of pituitary function.

1982 ◽  
Vol 56 (6) ◽  
pp. 857-860 ◽  
Author(s):  
Eugenio Pozzati ◽  
Giulio Gaist ◽  
Massimo Poppi

✓ Two cases of internal carotid artery occlusion secondary to spontaneous dissection are reported. Both patients presented with transient ischemic attacks. Both had antiplatelet aggregation therapy, followed by spontaneous resolution of the occlusion. The period of healing seems to be relatively short. In both cases, restoration of flow was angiographically documented 14 days and 10 weeks after the initial arteriogram. Strategies for treatment of such patients are discussed.


1987 ◽  
Vol 67 (4) ◽  
pp. 609-611 ◽  
Author(s):  
Patrick G. Ryan ◽  
Arthur L. Day

✓ A patient with known internal carotid artery occlusion developed transient ischemic attacks in the distribution of the occluded vessel. Arteriography demonstrated a thrombus clearly originating from the internal carotid artery stump, which was unassociated with significantly stenotic atherosclerotic disease of the ipsilateral common or external carotid arteries. Stump angioplasty and endarterectomy led to complete and sustained cessation of further symptoms.


1997 ◽  
Vol 86 (3) ◽  
pp. 567-570 ◽  
Author(s):  
Jason A. Heth ◽  
Christopher M. Loftus ◽  
John G. Piper ◽  
William Yuh

✓ The authors report the case of a patient with transient ischemic attacks who was evaluated by duplex scanning, which demonstrated total carotid artery occlusion. Arteriography revealed what appeared to be a classic “string sign” in the cervical carotid artery, and a standard endarterectomy was planned. At surgery the internal carotid artery was found to be congenitally atretic, accounting for the string appearance of the arteriogram. The etiology, associated anomalies, differential diagnosis, and diagnostic evaluation of such lesions are discussed.


1986 ◽  
Vol 65 (2) ◽  
pp. 249-252 ◽  
Author(s):  
Kevin M. McGrail ◽  
Roberto C. Heros ◽  
Gerard Debrun ◽  
Brian D. Beyerl

✓ A 44-year-old man experienced the sudden onset of horizontal diplopia and hemifacial numbness. Arteriography demonstrated a left intrapetrous carotid artery aneurysm. The patient was successfully treated with a left superficial temporal artery to middle cerebral artery bypass followed by balloon entrapment of the aneurysm. There have been at least 40 previously reported cases of aneurysms of the petrous portion of the carotid artery. These aneurysms can be mycotic, traumatic, or developmental in origin. They can present with massive otorrhagia or epistaxis from acute rupture or with decreased hearing and paresis of the fifth through eighth cranial nerves and, less frequently, of the ninth, 10th, and 12th cranial nerves caused by direct pressure. They can also produce pulsatile tinnitus, and sometimes they are discovered as a retrotympanic vascular mass during otological examination. The treatment of choice is carotid artery occlusion. Trapping of the aneurysm by detachable balloons eliminates immediately the risk of hemorrhage, offers the possibility of test occlusion of the internal carotid artery with the patient awake prior to permanent occlusion, and should also reduce the risk of thromboembolism. It should be preceded by a bypass procedure when preliminary evaluation indicates that the patient will not tolerate internal carotid artery occlusion.


1976 ◽  
Vol 44 (5) ◽  
pp. 620-622 ◽  
Author(s):  
Robert P. Meriwether ◽  
Hugh G. Barnett ◽  
Dean H. Echols

✓ The authors describe a case of subarachnoid hemorrhage secondary to moyamoya disease in an adult Negro. To the authors' knowledge, this is the first such case reported. Moyamoya, the Japanese word for “puff of smoke,” describes the characteristic angiographic appearance of the collateral arterial network associated with internal carotid artery occlusion. The cause is unknown. Treatment consists of supportive care; the prognosis is variable.


1998 ◽  
Vol 89 (4) ◽  
pp. 676-681 ◽  
Author(s):  
David W. Newell ◽  
Andrew T. Dailey ◽  
Stephen L. Skirboll

✓ The authors describe the use of a microanastomotic device to perform intracranial end-to-end vascular anastomoses. Direct end-to-end anastomosis was performed between the superficial temporal artery and branches of the middle cerebral artery (MCA) in three patients. Two patients had moyamoya disease, with severe proximal MCA disease, and one suffered an internal carotid artery occlusion with poor collateral flow. All patients reported a history of recent ischemic symptoms. Each anastomosis was accomplished in less than 15 minutes with technically satisfactory results. Postoperative angiographic studies demonstrated patency of the bypasses in all patients.


1977 ◽  
Vol 47 (4) ◽  
pp. 599-604 ◽  
Author(s):  
Thomas J. Rosenbaum ◽  
O. Wayne Houser ◽  
Edward R. Laws

✓ The authors report a case of pituitary apoplexy occurring several hours after carotid angiography. The event was associated with stupor, focal headache, and left hemiparesis. Repeat angiography demonstrated intracranial occlusion of the right internal carotid artery. At surgery, a hemorrhagic pituitary adenoma was found to be compressing the internal carotid artery, and the removal of the tumor resulted in restoration of flow. The mechanism, presenting symptoms and signs, and treatment of pituitary apoplexy causing compression of a major vessel are discussed.


1972 ◽  
Vol 36 (3) ◽  
pp. 351-354 ◽  
Author(s):  
Colin S. Doyle ◽  
Frederick A. Simeone

✓ A young man with a large sphenoid sinus mucocele developed hypopituitarism, headaches, and visual difficulties. Subsequently the lesion caused complete occlusion of both internal carotid arteries in the parasellar region. The headaches and visual difficulty improved after simple transoral drainage of the cyst.


1980 ◽  
Vol 53 (3) ◽  
pp. 300-304 ◽  
Author(s):  
Toshisuke Sakaki ◽  
Kazuhiko Kinugawa ◽  
Tatsuo Tanigake ◽  
Seiji Miyamoto ◽  
Kikuo Kyoi ◽  
...  

✓ Embolism from an aneurysm is one of the mechanisms involved in the pathogenesis of ischemic symptoms associated with intracranial aneurysms. Four cases are reported in which aneurysms of the internal carotid arteries and middle cerebral arteries were the source of emboli resulting in cerebral infarction. In the treatment of these aneurysms, it is best to clip the neck of the aneurysm with great care to avoid embolism due to extrusion of clot into the distal artery.


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