Udar przysadki po operacji serca u chorego z podklinicznym gruczolakiem przysadki: opis przypadku i przegląd piśmiennictwa

Abstract Pituitary adenoma infarction associated with cardiac surgery occurs rarely but it is a serious, life-threatening acute clinical event. Several mechanisms have been proposed but no direct cause has been clearly identified. We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery. The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.Streszczenie Zawał w obrębie gruczolaka przysadki związany z operacją serca występuje rzadko, ale jest stanem zagrożenia życia. Wskazywano na kilka mechanizmów wystąpienia tego powikłania, ale dotąd nie określono jednoznacznej przyczyny. Przedstawiono przypadek udaru przysadki, który wystąpił u 74-letniego mężczyzny po 6 godz. od operacji serca. U chorego zaobserwowano zmącenie, jednostronne opadnięcie powieki i zaburzenia gałkoruchowe. W badaniu neurologicznym stwierdzono porażenie prawego nerwu okoruchowego i zaburzenia przytomności. W badaniu za pomocą rezonansu magnetycznego uwidoczniono gruczolaka przysadki ze zmianami krwotocznymi i martwiczymi. Zaburzenia świadomości ustąpiły po niezwłocznym leczeniu hydrokortyzonem i lewotyroksyną. Usunięcie nieczynnego wydzielniczo gruczolaka z dużymi obszarami martwicy spowodowało powrót do zdrowia. Należy pamiętać o zawale w obrębie gruczolaka przysadki jako powikłaniu operacji na otwartym sercu. Nieleczona, choroba ta może doprowadzić do zgonu lub trwałych następstw neurologicznych bądx endokrynologicznych. Leczenie chirurgiczne i endokrynologiczne może być w tej sytuacji działaniem ratującym życie

Intermittent priapism in degenerative lumbar spinal stenosis: Case report

BACKGROUND: Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing and walking, relieved by sitting or lying. One of the uncommon symptoms is involuntary intermittent penile erection due to spinal canal stenosis. This symptom is very rare and often forgotten when history is taken

The Relationship of the Vertebral Artery with Anatomical Landmarks in the Posterior Craniovertebral Junction of Fresh Human Cadavers in the Turkish Population

AIM: Surgical anatomy concerning the posterior craniovertebral region in fresh human cadavers was studied to provide most accurate information for the surgical approach. MATERIAL and METHODS: In thirty-two fresh human cadavers, the distance from the posterior tubercle to the sulcus of vertebral artery (VA), the thickness and length of the third segment of VA (V3), the distance of C1/C2 facet to V3, the length, height and shape of the C2 ganglion to the neighboring structures, the distance from medial border of C1 lateral mass to dura mater, the distance of the transverse process of atlas to mastoid tip, the thickness of C1 posterior arcus were measured. RESULTS: There were variations of sulcus of VA in 14 of 32 cadavers (43.7%), the right VA was larger in 23 cadavers (71.8%). The ganglion was found over the C1 lateral mass screw entry point in 45 of 64 ganglions (70.31%) and below the screw entry point in 19 of 64 ganglions (29.69%). The distance of the medial border of the C1 lateral mass to dural tube was 3.81 +/- 0.55 mm at the right side and 3.91 +/- 0.59 mm at the left. The thickness of C1 posterior arch was 3.73 +/- 0.75 mm at the right side and 3.75 +/- 0.77 mm at the left. The mean distance from the transverse process of C1 to the mastoid tip was 15.82 +/- 4.49 mm at the right side and 15.46 +/- 4.38 mm at the left. CONCLUSION: This is the most comprehensive and only fresh cadaver study about this region in the literature

Chronic subdural hematoma after endoscopic third ventriculostomy: Case report

Endoscopic third ventriculostomy (ETV) is an effective and rather safe treatment for noncommunicating hydrocephalus secondary to aqueductal stenosis and other obstructive pathologies. It has become a popular alternative to ventricular shunts for noncommunicating hydrocephalus. Although it is a safe procedure, several complications related to this procedure have been reported in the literature. We report a rare case of a large chronic subdural hematoma (ChSDH) after ETV in a patient with aqueductal stenosis. A 42-year-old female patient presented with acute symptoms of obstructive hydrocephalus, headaches and blurring of consciousness. A computerized tomogram (CT) of the patient's brain revealed marked triventricular supratentorial hydrocephalus and an external ventricular drainage (EVD) was performed first. After this procedure, magnetic resonance imaging (MRI) demonstrated hydrocephalus secondary to aqueductal stenosis. ETV was performed and the EVD removed uneventfully. The patient was discharged home after a few days without any complications. She then presented with headaches 4 weeks following ETV. A CT demonstrated chronic subdural hematoma on the contralateral side. This was treated with burr-hole evacuation. Postoperatively, her headaches improved. During the follow-up period, she remains symptom-free and has radiographic evidence of a patent ventriculostomy. This case confirms chronic subdural hematoma formation is a possible complication following endoscopic third ventriculostomy

Effects of arterial and venous wall homogenates, arterial and venous blood, and different combinations to the cerebral vasospasm in an experimental model

Background: Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. However, ischemic neurologic deficits related to vasospasm are still the leading causes of mortality ami morbidity. It is well known that vasospasm is a dynamic process affected by various factors. The severity of vasospasm in animal models and clinical observations differ from each other. This variability has not been completely explained by blood and blood degradation products. Therefore, metabolites released from the damaged vessel wall during the bleeding are thought to play an important role in vasospasm

Anterolateral approach to the cervical spine: major anatomical structures and landmarks

Object. The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure

Spinal accessory nerve palsy following gunshot injury: a case report

Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and ann was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natural course and we performed external neurolysis for decompression. The postoperative period was uneventful. Dysesthesia has diminished slowly. He was transferred to physical rehabilitation unit. In his clinical control after 3 months he had no dysesthesia and neurological examination of the left trapezius and sternomastoid muscles motor function were 4/5. EMG showed recovery in the left spinal accessory nerve