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William T Couldwell - One of the best experts on this subject based on the ideXlab platform.
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Coexisting Rathke Cleft Cyst and Pituitary Adenoma Presenting with Pituitary Apoplexy: Report of Two Cases
2016Co-Authors: Florian Gessler, William T Couldwell, Valerie C. Coon, Steven S. Chin, Ph. DAbstract:The authors report two cases of coexisting Rathke cleft cyst (RCC) and Pituitary macroadenoma. Both patients presented at the university hospital with Pituitary Apoplexy symptoms of sudden-onset headache while undergoing treatment with Coumadin (warfarin). Magnetic resonance imaging was consistent with a Pituitary adenoma in one case and RCC in the other. Intraoperative findings and pathological work-up identified RCC along with adenomatous tissue displaying hemorrhagic Pituitary ad-enoma in one and hemorrhagic RCC in the other. Clinical symptoms of Pituitary Apoplexy were present in both cases, making Pituitary and RCC Apoplexy clinically indistinguishable. RCC and concomitant Pituitary adenoma are a rare intraoperative finding that must be considered as a differential diagnosis in patients with symptoms of Pituitary adenoma Apoplexy
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hemorrhagic and nonhemorrhagic rathke cleft cysts mimicking Pituitary Apoplexy
Journal of Neurosurgery, 2008Co-Authors: Mandy J Binning, James K Liu, John Gannon, Anne G Osborn, William T CouldwellAbstract:Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and Apoplexy is one of the most unusual presentations. Only a few cases of Apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated Pituitary Apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with Pituitary Apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal...
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Pituitary Apoplexy in the magnetic resonance imaging era clinical significance of sphenoid sinus mucosal thickening
Journal of Neurosurgery, 2006Co-Authors: James K Liu, William T CouldwellAbstract:Object The authors report their experience with Pituitary Apoplexy and evaluate the clinical significance of sphenoid sinus mucosal thickening found on magnetic resonance (MR) imaging. Methods The cases of 28 patients (19 males and nine females) with Pituitary Apoplexy were reviewed retrospectively. The mean age of the patients was 50 years (range 16–83 years), and the mean follow-up duration was 32 months (range 1–104 months). Admission MR imaging demonstrated hemorrhage or infarction in a Pituitary tumor in each patient. A clinical grading scale for Apoplexy was devised as follows: Grade I, presence of acute headache and/or endocrine abnormality (12 patients); Grade II, presence of the foregoing symptoms as well as cranial nerve deficit (visual and/or oculomotor; 15 patients); and Grade III, presence of all of these symptoms and a decreased level of consciousness (one patient). Twenty-five patients (89%) underwent early transsphenoidal resection within 9 days (80% within 72 hours) of diagnosis. Headache...
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Pituitary Apoplexy in the magnetic resonance imaging era clinical significance of sphenoid sinus mucosal thickening
Journal of Neurosurgery, 2006Co-Authors: William T CouldwellAbstract:OBJECT: The authors report their experience with Pituitary Apoplexy and evaluate the clinical significance of sphenoid sinus mucosal thickening found on magnetic resonance (MR) imaging. METHODS: The cases of 28 patients (19 males and nine females) with Pituitary Apoplexy were reviewed retrospectively. The mean age of the patients was 50 years (range 16-83 years), and the mean follow-up duration was 32 months (range 1-104 months). Admission MR imaging demonstrated hemorrhage or infarction in a Pituitary tumor in each patient. A clinical grading scale for Apoplexy was devised as follows: Grade I, presence of acute headache and/or endocrine abnormality (12 patients); Grade II, presence of the foregoing symptoms as well as cranial nerve deficit (visual and/or oculomotor; 15 patients); and Grade III, presence of all of these symptoms and a decreased level of consciousness (one patient). Twenty-five patients (89%) underwent early transsphenoidal resection within 9 days (80% within 72 hours) of diagnosis. Headaches and oculomotor paresis resolved completely in 100%, visual function resolved completely in 44% and partially in 56%, and hypopituitarism was reversed in 25%. Twelve patients (43%) required long-term hormone replacement therapy. Two of the three patients who were treated conservatively had prolactin-secreting adenomas, which were treated with dopamine agonist therapy. Thickening of sphenoid sinus mucosa was present in 22 patients (79%). Fifty percent of patients in Grade I and 100% of those in Grades II and III, including all those with persistent hypopituitarism and residual visual deficits, had thickened sphenoid sinus mucosa on MR imaging. Patients with thickened sphenoid sinus mucosa had larger tumors that compressed the optic chiasm or cavernous sinus, and these individuals also had a higher rate of cranial nerve deficits at presentation than those without mucosal thickening (73% compared with 0%). Patients with thickened mucosa had a higher rate of hypopituitarism and subsequent long-term hormone replacement therapy than those without thickened mucosa (55% compared with 17%). CONCLUSIONS: Thickened sphenoid sinus mucosa may correlate with higher grades of Pituitary Apoplexy and worse neurological and endocrinological outcomes.
Kanna K Gnanalingham - One of the best experts on this subject based on the ideXlab platform.
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sphenoid sinus mucosal thickening in the acute phase of Pituitary Apoplexy
Pituitary, 2017Co-Authors: Kanna K Gnanalingham, Tara Kearney, Mueez Waqar, Robert Mccreary, Konstantina KarabatsouAbstract:Purpose In Pituitary Apoplexy (PA), there are preliminary reports on the appearance of sphenoid sinus mucosal thickening (SSMT). SSMT is otherwise uncommon with an incidence of up to 7% in asymptomatic individuals. The aim of this study was to evaluate the incidence and clinical significance of SSMT in patients with PA and a control group of surgically treated non-functioning Pituitary adenomas (NFPAs).
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Pituitary Apoplexy bespoke patient management allows good clinical outcome
Clinical Endocrinology, 2016Co-Authors: Sumithra Giritharan, Kanna K Gnanalingham, Tara KearneyAbstract:SummaryObjective To describe the clinical presentation, management and outcome of Pituitary Apoplexy from a single centre and retrospectively apply the Pituitary Apoplexy Score (PAS). Design Retrospective review of patients presenting with classical Pituitary Apoplexy to a single neurosurgical centre in the Greater Manchester region. Results A total of 31 cases with classical Pituitary Apoplexy were identified between 2005 and 2014. The mean age at presentation was 55 years, and there were 19 men. In only one patient was there prior knowledge of a Pituitary adenoma. Eleven (35%) patients were managed conservatively and 20 (65%) patients managed surgically. Emergency surgery was carried out in 11 patients. At presentation, visual symptoms were present in a higher proportion of patients in the surgical group (90%) compared to the conservatively managed group (64%). At final follow-up, visual recovery was apparent in most patients in both the surgical (100%) and conservatively (86%) managed groups. The proportion of patients with hypopituitarism was high in both the surgical (86%) and conservative (73%) groups at presentation, and this failed to improve at final follow-up (90% vs 73%, respectively). The median PAS scores were higher in the surgical (PAS 2), compared to the conservatively managed group (PAS 0). Conclusion In Pituitary Apoplexy patients managed conservatively or surgically, there is good recovery of visual symptoms but not endocrine function. Patients should be managed on a case-by-case basis based on the severity of symptoms at presentation, progression of disease and surgical expertise available. Further prospective studies using the PAS are required to determine its usefulness in clinical practice.
Edward R Laws - One of the best experts on this subject based on the ideXlab platform.
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Pituitary Apoplexy correlation between magnetic resonance imaging and histopathological results
Journal of Neurosurgery, 2008Co-Authors: Patrick L Semple, John A Jane, Beatriz M S Lopes, Edward R LawsAbstract:Object The aim of this study was to correlate the magnetic resonance (MR) imaging findings in Pituitary Apoplexy with histopathological results and determine whether the histopathology influences clinical presentation and outcome. Methods The records of 36 patients with histologically confirmed Pituitary Apoplexy, who were treated surgically at the University of Virginia Health System between 1996 and 2006, were retrospectively reviewed. The MR images were divided into 3 groups: 1) infarction alone; 2) hemorrhage with or without infarction; and 3) tumor only with no evidence of Apoplexy. The histological examination was divided into infarction alone or hemorrhagic infarction/hemorrhage. The MR imaging findings were then correlated with the histopathological results to assess how accurately the histopathology was predicted by the MR imaging. The clinical features and outcomes of the two histopathological groups were also compared. Results The MR imaging findings were able to predict the histopathology accu...
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clinical relevance of precipitating factors in Pituitary Apoplexy
Neurosurgery, 2007Co-Authors: Patrick L Semple, John A Jane, Edward R LawsAbstract:OBJECTIVE The pathogenesis of Pituitary Apoplexy and the role of precipitating factors in Pituitary Apoplexy are poorly understood. Most of the published cases are in the form of case reports. We assessed the presumed precipitating factors in a series of patients treated surgically for Pituitary Apoplexy and reviewed the contemporary published literature. METHOD Thirty-eight consecutive patients with Pituitary Apoplexy were treated surgically by the Department of Neurosurgery at the University of Virginia, Charlottesville, VA, between January 1996 and March 2006. Their medical records were retrospectively reviewed. Contemporary published cases from 1990 to 2006 were also reviewed. RESULTS Nine patients (24%) were identified as having precipitating factors for Pituitary Apoplexy. The factors identified were coronary artery surgery (two patients), other major surgery (two patients), pregnancy (two patients), gamma knife irradiation, anticoagulant therapy, and coagulopathy secondary to liver failure. The presentation, histology, and outcome were compared between those patients with a precipitating factor and those in whom none was identified. A review of the published literature showed that coronary artery surgery, Pituitary stimulation, and coagulopathy were the most common precipitating factors. CONCLUSION A minority of patients with Pituitary Apoplexy will have precipitating factors. The majority of patients with precipitating factors will have histopathology showing hemorrhagic infarction or hemorrhage. The most common precipitating factors are Pituitary stimulation, surgery, particularly coronary artery surgery, and coagulopathy. Caution in doing endocrine investigation, surgery, or anticoagulation in patients with a known Pituitary tumor is advised. Patients with no diagnosed Pituitary tumor but with a known precipitating factor who have neuro-ophthalmological deterioration or endocrine failure should undergo prompt magnetic resonance image scans and endocrine investigation and endocrine replacement as indicated.
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Pituitary Apoplexy do histological features influence the clinical presentation and outcome
Journal of Neurosurgery, 2006Co-Authors: Patrick L Semple, Jacques C De Villiers, Beatriz M S Lopes, Robert M Bowen, Edward R LawsAbstract:Object A retrospective analysis of a contemporary series of patients with Pituitary Apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome. Methods A retrospective analysis was performed in 59 patients treated for Pituitary Apoplexy at the University of Virginia Health System, Charlottesville, Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa. The patients were divided into two groups according to the histological features of their disease: one group with infarction alone, comprising 22 patients; and the other with hemorrhagic infarction and/or frank hemorrhage, comprising 37 patients. The presenting symptoms, clinical features, endocrinological status, and outcome were compared between the two groups. Conclusions The patients who presented with histological features of Pituitary tumor infarction alone had less severe clinical features on presentation, a longer course prior to presentation, and a better outcome...
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Pituitary Apoplexy commentary
Neurosurgery, 2005Co-Authors: Patrick L Semple, Michael K Webb, Jacques C De Villiers, Edward R Laws, Kalmon D Post, Ivan Ciric, Rudolf FahlbuschAbstract:OBJECTIVE: Pituitary Apoplexy is a rare yet potentially fatal disease. We reviewed the combined experience of the University of Virginia in Charlottesville, VA, and Groote Schuur Hospital, University of Cape Town, South Africa, with 62 cases of Pituitary Apoplexy. METHODS: An Internet web site with a database was constructed, and the records of 62 patients were entered into the database from both institutions and then systematically analyzed. RESULTS: The average age of patients was 51.1 years; 60% were male, and the average length of follow-up was 55 months. The average time of presentation was 14.2 days after the ictus, and 81% had no previous history of Pituitary tumor. Headache was the most common presenting symptom (87%). Diminished visual acuity was found in 56% of patients, bitemporal hemianopia in 34%, ocular palsies in 45%, and diminished level of consciousness in 13%. Seventy-three percent of the patients had laboratory evidence of hypopituitarism, and 8% had diabetes insipidus. Fifty-eight patients underwent surgery, 3 were treated conservatively, and 1 died before intervention. Histological examination revealed hemorrhagic infarction in 47%, simple infarction in 40%, and frank hemorrhage in 8%. Seventy-nine percent had a good outcome, although 83% required subsequent hormonal replacement therapy. CONCLUSION: Pituitary Apoplexy is often misdiagnosed because the majority of patients have undetected Pituitary adenomas, and the presentation is often mistaken for subarachnoid hemorrhage. Most cases of Pituitary Apoplexy occur spontaneously, although precipitating factors have been suggested. Magnetic resonance imaging is the imaging modality of choice. Treatment includes high-dose corticosteroid administration and surgery. Transsphenoidal surgery is indicated in patients with diminished levels of consciousness, hypothalamic dysfunction, and visual deterioration. Conservative management for patients with isolated cranial nerve palsies has been advocated but remains controversial.
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a retrospective analysis of Pituitary Apoplexy
Neurosurgery, 1993Co-Authors: Douglas C Bills, Edward R Laws, Fredric B Meyer, Dudley H Davis, Michael J Ebersold, Bernd W Scheithauer, Duane M Ilstrup, Charles F AbboudAbstract:Thirty-seven patients with Pituitary Apoplexy were analyzed with an emphasis on clinical presentation and visual outcome. Their mean age was 56.6 years, with a male to female ratio of 2:1. Presenting symptoms included headache (95%), vomiting (69%), ocular paresis (78%), and reduction in visual fields (64%) or acuities (52%). Computed tomographic scanning correctly identified Pituitary hemorrhage in only 46% of those scanned. Thirty-six patients underwent transsphenoidal decompression. By immunostaining criteria, null-cell adenomas were the most frequent tumor type (50%). Long-term steroid or thyroid hormone replacement therapy was necessary in 82% and 89% of patients, respectively. Long-term desmopressin therapy was required in 11%, and 64% of the male patients required testosterone replacement therapy. Surgery resulted in improvement in visual acuity deficits in 88%, visual field deficits in 95%, and ocular paresis in 100%. Analysis of the degree of improvement in preoperative visual deficits with the timing of the surgery demonstrated that those who underwent surgery within a week of Apoplexy had significant recovery in their visual acuities. In the stable, conscious patient with residual vision in each eye, surgical decompression should be performed as soon as possible, because delays beyond 1 week may retard the return of visual function.
Patrick L Semple - One of the best experts on this subject based on the ideXlab platform.
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Pituitary Apoplexy correlation between magnetic resonance imaging and histopathological results
Journal of Neurosurgery, 2008Co-Authors: Patrick L Semple, John A Jane, Beatriz M S Lopes, Edward R LawsAbstract:Object The aim of this study was to correlate the magnetic resonance (MR) imaging findings in Pituitary Apoplexy with histopathological results and determine whether the histopathology influences clinical presentation and outcome. Methods The records of 36 patients with histologically confirmed Pituitary Apoplexy, who were treated surgically at the University of Virginia Health System between 1996 and 2006, were retrospectively reviewed. The MR images were divided into 3 groups: 1) infarction alone; 2) hemorrhage with or without infarction; and 3) tumor only with no evidence of Apoplexy. The histological examination was divided into infarction alone or hemorrhagic infarction/hemorrhage. The MR imaging findings were then correlated with the histopathological results to assess how accurately the histopathology was predicted by the MR imaging. The clinical features and outcomes of the two histopathological groups were also compared. Results The MR imaging findings were able to predict the histopathology accu...
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clinical relevance of precipitating factors in Pituitary Apoplexy
Neurosurgery, 2007Co-Authors: Patrick L Semple, John A Jane, Edward R LawsAbstract:OBJECTIVE The pathogenesis of Pituitary Apoplexy and the role of precipitating factors in Pituitary Apoplexy are poorly understood. Most of the published cases are in the form of case reports. We assessed the presumed precipitating factors in a series of patients treated surgically for Pituitary Apoplexy and reviewed the contemporary published literature. METHOD Thirty-eight consecutive patients with Pituitary Apoplexy were treated surgically by the Department of Neurosurgery at the University of Virginia, Charlottesville, VA, between January 1996 and March 2006. Their medical records were retrospectively reviewed. Contemporary published cases from 1990 to 2006 were also reviewed. RESULTS Nine patients (24%) were identified as having precipitating factors for Pituitary Apoplexy. The factors identified were coronary artery surgery (two patients), other major surgery (two patients), pregnancy (two patients), gamma knife irradiation, anticoagulant therapy, and coagulopathy secondary to liver failure. The presentation, histology, and outcome were compared between those patients with a precipitating factor and those in whom none was identified. A review of the published literature showed that coronary artery surgery, Pituitary stimulation, and coagulopathy were the most common precipitating factors. CONCLUSION A minority of patients with Pituitary Apoplexy will have precipitating factors. The majority of patients with precipitating factors will have histopathology showing hemorrhagic infarction or hemorrhage. The most common precipitating factors are Pituitary stimulation, surgery, particularly coronary artery surgery, and coagulopathy. Caution in doing endocrine investigation, surgery, or anticoagulation in patients with a known Pituitary tumor is advised. Patients with no diagnosed Pituitary tumor but with a known precipitating factor who have neuro-ophthalmological deterioration or endocrine failure should undergo prompt magnetic resonance image scans and endocrine investigation and endocrine replacement as indicated.
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Pituitary Apoplexy do histological features influence the clinical presentation and outcome
Journal of Neurosurgery, 2006Co-Authors: Patrick L Semple, Jacques C De Villiers, Beatriz M S Lopes, Robert M Bowen, Edward R LawsAbstract:Object A retrospective analysis of a contemporary series of patients with Pituitary Apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome. Methods A retrospective analysis was performed in 59 patients treated for Pituitary Apoplexy at the University of Virginia Health System, Charlottesville, Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa. The patients were divided into two groups according to the histological features of their disease: one group with infarction alone, comprising 22 patients; and the other with hemorrhagic infarction and/or frank hemorrhage, comprising 37 patients. The presenting symptoms, clinical features, endocrinological status, and outcome were compared between the two groups. Conclusions The patients who presented with histological features of Pituitary tumor infarction alone had less severe clinical features on presentation, a longer course prior to presentation, and a better outcome...
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Pituitary Apoplexy commentary
Neurosurgery, 2005Co-Authors: Patrick L Semple, Michael K Webb, Jacques C De Villiers, Edward R Laws, Kalmon D Post, Ivan Ciric, Rudolf FahlbuschAbstract:OBJECTIVE: Pituitary Apoplexy is a rare yet potentially fatal disease. We reviewed the combined experience of the University of Virginia in Charlottesville, VA, and Groote Schuur Hospital, University of Cape Town, South Africa, with 62 cases of Pituitary Apoplexy. METHODS: An Internet web site with a database was constructed, and the records of 62 patients were entered into the database from both institutions and then systematically analyzed. RESULTS: The average age of patients was 51.1 years; 60% were male, and the average length of follow-up was 55 months. The average time of presentation was 14.2 days after the ictus, and 81% had no previous history of Pituitary tumor. Headache was the most common presenting symptom (87%). Diminished visual acuity was found in 56% of patients, bitemporal hemianopia in 34%, ocular palsies in 45%, and diminished level of consciousness in 13%. Seventy-three percent of the patients had laboratory evidence of hypopituitarism, and 8% had diabetes insipidus. Fifty-eight patients underwent surgery, 3 were treated conservatively, and 1 died before intervention. Histological examination revealed hemorrhagic infarction in 47%, simple infarction in 40%, and frank hemorrhage in 8%. Seventy-nine percent had a good outcome, although 83% required subsequent hormonal replacement therapy. CONCLUSION: Pituitary Apoplexy is often misdiagnosed because the majority of patients have undetected Pituitary adenomas, and the presentation is often mistaken for subarachnoid hemorrhage. Most cases of Pituitary Apoplexy occur spontaneously, although precipitating factors have been suggested. Magnetic resonance imaging is the imaging modality of choice. Treatment includes high-dose corticosteroid administration and surgery. Transsphenoidal surgery is indicated in patients with diminished levels of consciousness, hypothalamic dysfunction, and visual deterioration. Conservative management for patients with isolated cranial nerve palsies has been advocated but remains controversial.
James K Liu - One of the best experts on this subject based on the ideXlab platform.
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delayed postoperative Pituitary Apoplexy after endoscopic transsphenoidal resection of a giant Pituitary macroadenoma
Skull Base Surgery, 2012Co-Authors: Smruti K Patel, James K Liu, Lana D Christiano, Jean Anderson EloyAbstract:Postoperative Pituitary Apoplexy is rare and usually occurs in the immediate postoperative period (within 12 hours) after subtotal resection of giant Pituitary macroadenomas with fatal outcomes. We describe a unique patient with Pituitary Apoplexy occurring in a delayed fashion on the third postoperative day. Early detection and emergent endoscopic transsphenoidal exploration resulted in gross total removal of the residual tumor, decompression of the optic chiasm, and a favorable neurologic outcome.
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hemorrhagic and nonhemorrhagic rathke cleft cysts mimicking Pituitary Apoplexy
Journal of Neurosurgery, 2008Co-Authors: Mandy J Binning, James K Liu, John Gannon, Anne G Osborn, William T CouldwellAbstract:Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and Apoplexy is one of the most unusual presentations. Only a few cases of Apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated Pituitary Apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with Pituitary Apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal...
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Pituitary Apoplexy in the magnetic resonance imaging era clinical significance of sphenoid sinus mucosal thickening
Journal of Neurosurgery, 2006Co-Authors: James K Liu, William T CouldwellAbstract:Object The authors report their experience with Pituitary Apoplexy and evaluate the clinical significance of sphenoid sinus mucosal thickening found on magnetic resonance (MR) imaging. Methods The cases of 28 patients (19 males and nine females) with Pituitary Apoplexy were reviewed retrospectively. The mean age of the patients was 50 years (range 16–83 years), and the mean follow-up duration was 32 months (range 1–104 months). Admission MR imaging demonstrated hemorrhage or infarction in a Pituitary tumor in each patient. A clinical grading scale for Apoplexy was devised as follows: Grade I, presence of acute headache and/or endocrine abnormality (12 patients); Grade II, presence of the foregoing symptoms as well as cranial nerve deficit (visual and/or oculomotor; 15 patients); and Grade III, presence of all of these symptoms and a decreased level of consciousness (one patient). Twenty-five patients (89%) underwent early transsphenoidal resection within 9 days (80% within 72 hours) of diagnosis. Headache...