1/212. vitamin e deficiency ataxia associated with adenoma.Vitamin E is one of the most important lipid-soluble antioxidant nutrient. Severe vitamin e deficiency (VED) can have a profound effect on the central nervous system. VED causes ataxia and peripheral neuropathy that resembles Friedreich's ataxia. We report here a patient presenting this syndrome, but also a prolactin and FSH adenoma. Both the neurological syndromes and the adenoma regressed after treatment with alpha-tocopherol. Although, the presence of the prolactinoma in this patient may not be related to his vitamin e deficiency, alpha-tocopherol treatment seems to be beneficial and might usefully be tested in patients with hypophyseal secreting other forms of adenoma.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/212. Post-traumatic pituitary apoplexy--two case reports.A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. skull radiography showed a unilateral linear occipital fracture. magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
3/212. December 1998--16 year old female with headaches, lethargy and a sellar/suprasellar mass.A 16 year female with a history of developmental delay and shunted hydrocephalus presented with two months of progressive headaches, lethargy and visual disturbances. An MRI of the brain revealed a sellar and suprasellar cystic mass which was absent on a previous MRI six years earlier. The pre-operative clinical diagnosis was pituitary adenoma vs. craniopharyngioma. Histologically, the fibrous wall of the ciliated epithelial-lined cyst was thickened by non-caseating granulomatous inflammation, hemorrhage, hemosiderin, and cholesterol clefts, consistent with cyst rupture. Rathke's cleft cysts are uncommon symptomatic lesions in young people, and must be distinguished from craniopharyngioma.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
4/212. An ACTH-producing pituitary carcinoma developing Cushing's disease.An autopsy case of an ACTH-producing pituitary carcinoma in a 59-year-old man who developed Cushing's disease is reported. The surgically removed pituitary tumor was diagnosed as chromophobe adenoma, however, pulmonary metastases appeared 2 years after the operation. autopsy revealed a residual pituitary tumor in the sella turcica with systemic metastases to the lungs, liver, pulmonary lymph nodes, hypothalamus, dura mater, and the subarachnoid space of the midbrain and spinal cord. immunohistochemistry revealed ACTH positivity in the tumor cells. Further immunohistochemical study showed positive high expression of Ki-67 in the tumor removed at surgery as well as in the autopsied tumor. Ki-67 labeling index provided valuable information about the invasive and proliferative potential compared to noninvasive benign pituitary adenoma.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
5/212. Hypophyseal non-Hodgkin's lymphoma presenting with diabetes insipidus: a case report.We report the case of a 64 year old male patient with a history of ischemic heart disease who underwent surgery for an abdominal mass. The histological diagnosis was highly malignant non-Hodgkin's lymphoma. After surgery the patient was admitted to our Department and received 6 courses of chemotherapy according to the COP schedule, followed by radiotherapy to the left upper abdominal region and ipsilateral lung base. The patient achieved partial remission. One month later he began to complain of left axillary lymphadenomegaly, polydipsia and polyuria. A NMR brain scan showed a hypophyseal mass. The patient was treated with DDAVP and chemotherapy with the PRO-MACE protocol; the polyuria and lymphadenomegaly disappeared and the size of the hypophyseal mass reduced markedly. The clinical picture was, therefore, attributed to a hypophyseal localization of the non-Hodgkin's lymphoma, which is a very rare manifestation of lymphomatous spread to the central nervous system. Our case is also interesting because it shows that a favorable outcome can be obtained with chemotherapy, provided that the latter is sufficiently aggressive. This is not necessarily the case with radiotherapy which may also be followed by late and severe neurologic sequelae.- - - - - - - - - - ranking = 2.1707087298768keywords = brain, central nervous system, nervous system (Clic here for more details about this article) |
6/212. Metastatic craniopharyngioma.We report a unique case of metastatic craniopharyngioma. Initially, the patient had a right frontal craniotomy for resection of a suprasellar mass, which was determined to be an adamantinomatous craniopharyngioma. Seven years later, an MR study of the brain showed two peripheral enhancing lesions adjacent to the dura and contralateral to the craniotomy site. Pathologic examination again showed adamantinomatous craniopharyngioma. Although recurrence, both local and along surgical tracts due to implantation of craniopharyngioma tissue, has been reported, this case raises the possibility of meningeal seeding to remote sites.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
7/212. Non-functioning pituitary tumour after long-term treatment with gonadotrophin-releasing hormone agonists in a patient with vaginal agenesis who underwent neovaginoplasty and cauterization of endometriosis under laparoscopy.Vaginal agenesis combined with a functional uterus is a rare condition in which treatment modalities that preserve reproductive function are controversial. A 21 year old female presented with congenital vaginal agenesis combined with cervical atresia. She was treated with gonadotrophin-releasing hormone (GnRH) agonists for a total period of over 5 years when a non-functioning pituitary tumour was detected by brain magnetic resonance imaging (MRI). A laparoscopically assisted reconstruction of a neovagina and neoendocervical canal was performed utilizing lyophilized porcine dermal skin to line the neovagina. endometriosis of the pelvis was revealed and adhesiolysis and cauterization were also carried out under laparoscopy. The GnRH agonist was discontinued and the patient resumed cyclic menses with no abdominal pain. The pituitary tumour decreased in size 6 months after the cessation of GnRH agonists. We raise the question as to whether pituitary MRI should be performed for patients who need long-term administration of GnRH agonists.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
8/212. Value of Ga-67 SPECT in monitoring the effects of therapy in invasive aspergillosis of the sphenoid sinus.PURPOSE: We report a case of invasive sphenoid sinus aspergillosis clinically presenting as a pituitary mass. methods: After exploration via the trans-sphenoidal approach and subsequent treatment with amphotericin-B, Ga-67 brain SPECT was performed twice to monitor the therapeutic effect. RESULTS: Three months after antifungal treatment, Ga-67 brain SPECT showed partial resolution of the lesion in the sella turcica region. The patient continued with fluconazole treatment for another 2 months and received another Ga-67 brain SPECT, which showed complete clearing of the previous lesion. CONCLUSION: Ga-67 brain SPECT may play a potentially useful role in monitoring the therapeutic effect of treatment of invasive sphenoid sinus aspergillosis.- - - - - - - - - - ranking = 4.6828349195074keywords = brain (Clic here for more details about this article) |
9/212. Resection of a Langerhans cell histiocytosis granuloma of the hypothalamus: case report.The natural course and optimal treatment for isolated hypothalamic Langerhans cell histiocytosis (LCH) are unknown. We describe an adult female in whom total resection of a hypothalamic LCH granuloma was performed 12 years after transphenoidal resection of a pituitary adenoma. A retrospective review of the histological specimen of the first operation revealed CD1a positive cells characteristic of LCH along with a plurihormonal adenoma 12 years earlier. No other manifestations of LCH were found and MRI of the brain at the last follow-up 4 years after surgery did not show any recurrent or additional lesion. The diagnosis of isolated hypothalamic LCH is only possible by biopsy and our case demonstrates the feasability of a gross total resection in certain cases.- - - - - - - - - - ranking = 1.1707087298768keywords = brain (Clic here for more details about this article) |
10/212. hypothermia: a natural cause of death.Deaths due to hypothermia are usually accidental and are the result of exposure to extreme environmental temperatures. Often these individuals are intoxicated, elderly, or exposed to severe cold temperatures. We report the case of a blind, nonambulatory, elderly man who was found alive in his home in an unresponsive state. Core body temperature at hospital was 24 degrees C (75 degrees F). At autopsy, punctate hemorrhages were present in the stomach mucosa. A 4- x 7-cm pituitary adenoma extended from a dilated sella turcica, obliterated the optic chiasm, and compressed the base of the brain in the region of the hypothalamus. Compression in this region of the brain would disrupt the temperature regulatory function of the hypothalamus and create an individual who would be susceptible to minor fluctuations in ambient temperature. The manner of death was designated as natural. This is an unusual presentation of a pituitary adenoma in the current era of advanced imaging techniques in which microadenomas are often detected and treated.- - - - - - - - - - ranking = 2.3414174597537keywords = brain (Clic here for more details about this article) |
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