Symptoms of pituitary apoplexy rapidly reversed with bromocriptine

1996 ◽  
Vol 85 (6) ◽  
pp. 1153-1155 ◽  
Author(s):  
Michael H. Brisman ◽  
Gillian Katz ◽  
Kalmon D. Post
Keyword(s):  
Emergency Surgery ◽  
Visual Function ◽  
Prolactin Level ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rapid Progression ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print

✓ Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

scholarly journals Symptoms of pituitary apoplexy rapidly reversed with bromocriptine

1996 ◽  
Vol 1 (1) ◽  
pp. E8 ◽  
Author(s):  
Michael H. Brisman ◽  
Gillian Katz ◽  
Kalmon D. Post
Keyword(s):  
Steroid Therapy ◽  
Emergency Surgery ◽  
Visual Function ◽  
Prolactin Level ◽  
Pituitary Tumor ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rapid Progression ◽  
Third Nerve Palsy ◽  
Third Nerve

Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine therapy, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

Aneurysm-induced third nerve palsy

1972 ◽  
Vol 36 (5) ◽  
pp. 548-551 ◽  
Author(s):  
Iftikhar A. Raja
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Recovery ◽  
Poor Prognosis ◽  
Nerve Palsy ◽  
Nerve Function ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Carotid Ligation ◽  
Third Nerve ◽  
Fine Print

✓ Forty-two patients with aneurysm-induced third nerve palsy are described. After carotid ligation, 58% showed satisfactory and 42% unsatisfactory functional recovery. In some patients the deficit continued to increase even after carotid ligation. Early ligation provided a better chance of recovery of third nerve function. Patients in whom third nerve palsy began after subarachnoid hemorrhage had a poor prognosis. No relationship was noted between the size of the aneurysm and the recovery of third nerve function.

Computerized tomography angiography in isolated third nerve palsies

1998 ◽  
Vol 88 (4) ◽  
pp. 679-684 ◽  
Author(s):  
Robert M. McFadzean ◽  
Evelyn M. Teasdale
Keyword(s):  
Cerebral Aneurysm ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Angiography ◽  
Diagnostic Tool ◽  
Nerve Palsy ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print

Object. The goal of this study was to assess the value of computerized tomography (CT) angiography as a diagnostic tool in isolated oculomotor nerve palsies. Methods. One hundred consecutive patients who presented with an isolated third nerve palsy were examined by CT angiography. This procedure was followed by conventional cerebral angiography in most patients in whom a vascular abnormality was noted on the CT angiography. Thus, all patients whose symptoms were caused by a compressive aneurysm were identified. The remaining patients were observed clinically to exclude the possibility that a missed cerebral aneurysm caused the isolated third nerve palsy. Eighteen patients harbored a cerebral aneurysm responsible for causing the isolated third nerve palsy. Most of the remaining patients experienced some degree of spontaneous recovery. There was no clinical evidence to indicate that a case of compressive cerebral aneurysm causing the isolated third nerve palsy had been missed on CT angiography. Conclusions. Computerized tomography angiography is a reliable diagnostic tool for use in the assessment of patients with an isolated third nerve palsy; it can identify the minority of patients in whom conventional cerebral angiography may be required.

Aberrant regeneration in idiopathic oculomotor nerve palsy

1980 ◽  
Vol 52 (6) ◽  
pp. 854-856 ◽  
Author(s):  
Jose F. Laguna ◽  
Michael S. Smith
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Aberrant Regeneration ◽  
Oculomotor Function ◽  
Third Nerve ◽  
Fine Print

✓ Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating artery aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration.

Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions

1978 ◽  
Vol 49 (5) ◽  
pp. 635-649 ◽  
Author(s):  
Gérard Debrun ◽  
Pierre Lacour ◽  
Jean-Pierre Caron ◽  
Michel Hurth ◽  
Jean Comoy ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Vascular Lesions ◽  
Detachable Balloon ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print ◽  
Cerebral Vascular

✓ Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 posttraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.

Direct embolectomy of the basilar artery bifurcation

1992 ◽  
Vol 77 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Michael K. Morgan ◽  
Michael T. Biggs
Keyword(s):  
Basilar Artery ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Therapeutic Embolization ◽  
Good Recovery ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Neurologically Normal ◽  
Third Nerve ◽  
Fine Print

✓ The case is presented of a 27-year-old man who developed a basilar artery bifurcation embolus encompassing Hilal microcoil as a complication following therapeutic embolization. An immediate direct surgical approach to the basilar artery bifurcation enabled the microcoil and associated thrombus to be removed and flow to be restored in the basilar artery and its distal branches. Postoperatively, the patient made a good recovery and on discharge was neurologically normal with the exception of a right third nerve palsy. This case suggests that in selected patients a direct surgical approach to the top of the basilar artery may be possible for treatment of emboli.

PO17-TU-09 Pituitary apoplexy presenting with bilateral third nerve palsy and bilateral proptosis: case report

2009 ◽  
Vol 285 ◽  
pp. S241-S242
Author(s):  
G. Ayberk ◽  
H.F. Komurcu ◽  
M.F. Ozveren ◽  
N. Ozturk ◽  
O. Anlar
Keyword(s):  
Case Report ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Third Nerve Palsy ◽  
Third Nerve

scholarly journals Sudden onset isolated complete third nerve palsy due to pituitary apoplexy

2011 ◽  
Vol 4 (1) ◽  
pp. 32 ◽  
Author(s):  
Batuk Diyora ◽  
Naren Nayak ◽  
Sanjay Kukreja ◽  
Hanmant Kamble
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Third Nerve Palsy ◽  
Third Nerve

scholarly journals Gonadotropin-releasing hormone agonist-induced pituitary apoplexy

2016 ◽  
Vol 2016 ◽  
Author(s):  
Fergus Keane ◽  
Aoife M Egan ◽  
Patrick Navin ◽  
Francesca Brett ◽  
Michael C Dennedy
Keyword(s):  
Gnrh Agonist ◽  
Nerve Palsy ◽  
Gnrh Antagonist ◽  
Pituitary Apoplexy ◽  
Data Interpretation ◽  
Gonadotropin Releasing Hormone ◽  
Pituitary Macroadenoma ◽  
Agonist Therapy ◽  
Third Nerve Palsy ◽  
Third Nerve

Summary Pituitary apoplexy represents an uncommon endocrine emergency with potentially life-threatening consequences. Drug-induced pituitary apoplexy is a rare but important consideration when evaluating patients with this presentation. We describe an unusual case of a patient with a known pituitary macroadenoma presenting with acute-onset third nerve palsy and headache secondary to tumour enlargement and apoplexy. This followed gonadotropin-releasing hormone (GNRH) agonist therapy used to treat metastatic prostate carcinoma. Following acute management, the patient underwent transphenoidal debulking of his pituitary gland with resolution of his third nerve palsy. Subsequent retrospective data interpretation revealed that this had been a secretory gonadotropinoma and GNRH agonist therapy resulted in raised gonadotropins and testosterone. Hence, further management of his prostate carcinoma required GNRH antagonist therapy and external beam radiotherapy. This case demonstrates an uncommon complication of GNRH agonist therapy in the setting of a pituitary macroadenoma. It also highlights the importance of careful, serial data interpretation in patients with pituitary adenomas. Finally, this case presents a unique insight into the challenges of managing a hormonal-dependent prostate cancer in a patient with a secretory pituitary tumour. Learning points While non-functioning gonadotropinomas represent the most common form of pituitary macroadenoma, functioning gonadotropinomas are exceedingly rare. Acute tumour enlargement, with potential pituitary apoplexy, is a rare but important adverse effect arising from GNRH agonist therapy in the presence of both functioning and non-functioning pituitary gonadotropinomas. GNRH antagonist therapy represents an alternative treatment option for patients with hormonal therapy-requiring prostate cancer, who also have diagnosed with a pituitary gonadotropinoma.

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