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Journal of Korean Neurosurgical Society 1977;6(2): 491-498.
Two Cases of Pituitary Apoplexy.
Yong Park, Sung Jin Han, Choon Woong Huh, Jin Un Song
Department of Neurosurgery, Catholic Medical College, Seoul, Korea.
ABSTRACT
Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
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