Severe, sudden onset Headache in a young man: Sub-arachnoid Haemorrhage vs. Pituitary Apoplexy

10.5580/1d5e ◽  
2007 ◽  
Vol 7 (1) ◽  
Keyword(s):  
Pituitary Apoplexy ◽  
Sudden Onset

Partially Thrombosed Aneurysm Presenting as the Sudden Onset of Bitemporal Hemianopsia

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 564-566 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Computed Tomography ◽  
Cerebral Angiography ◽  
Pituitary Apoplexy ◽  
Preoperative Evaluation ◽  
Artery Aneurysm ◽  
Sudden Onset ◽  
Warning Signs ◽  
Anterior Communicating Artery ◽  
Computed Tomographic ◽  
Partial Thrombosis

Abstract A case is presented in which the sudden onset of bitemporal hemianopsia was caused by partial thrombosis associated with enlargement of an unruptured anterior communicating artery aneurysm. The features of the sequential computed tomographic scans resembled those of pituitary apoplexy, reemphasizing the necessity for cerebral angiography in preoperative evaluation. The clinical significance of the warning signs of cerebral aneurysm during the era of computed tomography is discussed. (Neurosurgery 22:564-566, 1988)

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.

Pituitary apoplexy presenting as multiple ocular nerve palsies of sudden onset

1993 ◽  
Vol 7 (4) ◽  
pp. 443-445 ◽  
Author(s):  
David Frederick Anderson ◽  
Farhad Afshar
Keyword(s):  
Pituitary Apoplexy ◽  
Sudden Onset

scholarly journals Uncontrolled diabetes as a rare presenting cause of pituitary apoplexy

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-228161
Author(s):  
Ashima Mittal ◽  
Sanat Mishra ◽  
Karamvir Yadav ◽  
Rajesh Rajput
Keyword(s):  
Pituitary Apoplexy ◽  
Field Testing ◽  
Sudden Onset ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Serum Prolactin ◽  
Pupillary Reflex ◽  
Uncontrolled Diabetes ◽  
The Right ◽  
Stimulating Hormone

Pituitary apoplexy is a rare endocrine emergency. The extent to which hyperglycaemia is a contributory risk factor in the precipitation of pituitary apoplexy is not known. A 38-year-old man with poorly controlled diabetes presented to the emergency department with sudden onset of nausea and headache with drooping of his right eyelid for about 4 days. On physical examination, he had orthostatic hypotension, ptosis of the right eye, lateral and downward positioning of the eye and absent pupillary reflex. Visual field testing of the left eye revealed superolateral quadrantanopia. MRI of the brain showed pituitary macroadenoma with necrosis. Investigations showed hyperglycaemia, decreased T3, T4 with normal Thyroid stimulating hormone (TSH), low serum Leutinizing hormone (LH), Follicle stimulating hormone (FSH), testosterone and low normal serum prolactin levels. About 21% of non-functioning pituitary adenomas present with apoplexy as was seen in our patient. It is likely that his uncontrolled diabetes precipitated this episode of apoplexy as hyperosmolarity and dehydration, caused by hyperglycaemia can lead to changed pituitary microvascular environment increasing the risk of pituitary infarction.

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 Pituitary Apoplexy, Meningitis and Cerebral Infarction - A Perplexing Trifecta

2021 ◽  
Author(s):  
Thirumalai V. Srivatsan ◽  
Haroon M. Pillay ◽  
Lakshay Raheja
Keyword(s):  
Cerebral Infarction ◽  
Visual Loss ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Rapid Progression ◽  
Altered Consciousness ◽  
Cerebral Infarcts ◽  
Endocrine Disturbances ◽  
Rare Manifestation

AbstractPituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together.We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.

Pituitary Apoplexy with raised intracranial pressure

2020 ◽  
Vol 17 (1) ◽  
pp. 41-43
Author(s):  
Bibesh Pokhrel ◽  
Amit Thapa
Keyword(s):  
Pituitary Apoplexy ◽  
Histopathological Examination ◽  
Sudden Onset ◽  
Visual Field Defects ◽  
Good Recovery ◽  
Acute Hemorrhage ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Tumor Specimen ◽  
Adenomatous Tissue ◽  
Sellar Floor

Pituitary apoplexy in pre-existing pituitary adenomas occurs as a consequence of acute hemorrhage or infarction. Patients with pituitary apoplexy present with sudden onset headache, vomiting, clouding of consciousness and visual field defects or total oculomotor palsies without any prior diagnosis of pituitary tumor. In this case report, we report a case of 52 years female who presented to the emergency department with headache throughout her head and periorbital area with vomiting. Investigations revealed sellar cystic lesion suggestive of pituitary apoplexy with normal hormonal profile. She underwent endoscopic trans-nasal trans-sphenoidal surgery with complete resection of pituitary adenoma. Histopathological examination of tumor specimen showed large areas of necrosis with blood surrounded by the adenomatous tissue. Post-operatively she had cerebrospinal fluid rhinorrhea with persistent papilledema and hydrocephalus. Sellar floor repair along with theco-peritoneal shunt lead to good recovery.  

scholarly journals Rapid Pituitary Apoplexy Regression: What Is the Time Course of Clot Resolution?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Devon L. Jackson ◽  
Jamie J. Van Gompel
Keyword(s):  
Time Course ◽  
Spontaneous Regression ◽  
Pituitary Apoplexy ◽  
Mass Effect ◽  
Sudden Onset ◽  
Pituitary Mass ◽  
Initial Event ◽  
Original Size ◽  
Visual Complaints

A 29-year-old male patient with a functioning pituitary macroadenoma is discussed. The pituitary mass was detected by MRI after the patient presented with sudden onset of headache, suggestive of an apoplectic event. The headache resolved with analgesic medications. Within a follow-up period of one week, the pituitary mass had spontaneously regressed to nearly half its original size without any therapy. The patient never reported any visual complaints and displayed no signs of hypopituitarism. Elevated prolactin levels were present. Seven weeks after the initial event, the pituitary mass showed continued regression on MRI. Prolactin levels remained elevated. This case provides a unique look at the rapid spontaneous regression of mass effect that may occur following apoplexy of a pituitary adenoma.

scholarly journals Spontaneous retroclival hematoma in pituitary apoplexy: case series

2015 ◽  
Vol 123 (3) ◽  
pp. 808-812 ◽  
Author(s):  
Avetis Azizyan ◽  
Joseph M. Miller ◽  
Ramzi I. Azzam ◽  
Marcel M. Maya ◽  
Pouyan Famini ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Case Series ◽  
Visual Disturbance ◽  
Sudden Onset ◽  
Laboratory Findings ◽  
Presenting Symptoms

OBJECT Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. METHODS This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. RESULTS Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. CONCLUSIONS Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

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.

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