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Hypothalamic Lesion


Presentation

  • A 38-year-old man presented with chronic hypothermia. He also had evidence of hypothalamo-pituitary dysfunction and CT scans showed a discrete hypothalamic lesion.[ncbi.nlm.nih.gov]
  • Despite the seldom occurrence of SIADH in MS, hypothalamic lesions are more common than appreciated and should be considered in patients presenting with hyponatremia or endocrinopathy symptoms.[ncbi.nlm.nih.gov]
  • All cases in present study responded well to pharmacotherapy and surgery was not required.[annalsofian.org]
  • In younger patients germinomas often present themselves through precocious puberty, a condition in which the onset of puberty is significantly premature, often before the age of eight (Klaus,n.d).[123helpme.com]
  • In controls no demyelinating lesions were seen but in 11 control cases HLA expression was observed that was lower than that present in MS patients (p 0.02).[ncbi.nlm.nih.gov]
Fever
  • We report a patient with tuberculous meningitis who continued to have persistent fever despite the satisfactory treatment of her tuberculosis.[vivo.med.cornell.edu]
  • Fever is the most common disorder of thermoregulation.[nba.uth.tmc.edu]
  • By reducing the activity of warm-sensitive neurons and increasing the activity of cold-sensitive neurons, pyrogens cause fever, a state in which all thermoregulatory responses have elevated set-point temperatures.[ncbi.nlm.nih.gov]
  • […] in a dog, antithyroid antibodies led to hypothyroidism and adipsia, both of which resolved with levothyroxine therapy. [4] "Sickness behavior" is a condition in animals in which systemic infection leads to a highly regulated set of responses such as fever[emedicine.medscape.com]
  • […] oxytocin levels reduce repetitive behaviors and improved ability to interpret emotions water inteake (thirst center) inhibit food intake (satiety center); docility homeostasis-- also respiratory center regulates response to heat -- PNS outflow GnRH, LHRH, fever[quizlet.com]
Hypothermia
  • A 38-year-old man presented with chronic hypothermia. He also had evidence of hypothalamo-pituitary dysfunction and CT scans showed a discrete hypothalamic lesion.[ncbi.nlm.nih.gov]
  • Figure 3.7 Emergencies of Thermoregulation Hypothermia is defined as a core temperature of 35 degrees or lower and represents a potential medical emergency.[nba.uth.tmc.edu]
  • Periodic disorders. 28.1 Kleine-Levin syndrome (periodic somnolence and morbid hunger). 28.2 Spontaneous periodic fever, hypothermia, Shapiro syndrome and periodic Cushing's syndrome. 28.3 Acute intermittent porphyria. 28.4 Narcolepsy. 28.5 Epileptic[elsevier.com]
  • Although periodic hypothermia or hyperthermia has been occasionally reported in MS, hyperthemia and disturbances in the sleep-wake cycle and amenorrhea as a result of hypothalamic disease have not been previously reported among subjects with MS.[ajnr.org]
  • Structural causes of obesity, anorexia, central hypothermia and hyperthermia, insomnia, and hypersomnia are only very rarely demonstrated.[ajnr.org]
Family History of Epilepsy
  • There was no family history of epilepsy. Patient was mentally retarded.[annalsofian.org]
Increased Appetite
  • DYSTROPHIA ADIPOSOGENITALIS  Characterized by increased appetite and depressed secretion of gonadotropin  Obesity and sexual infantilism  Associated with dwarfism (if the condition occurs during growing period)  It is also called Frohlich’s syndrome[de.slideshare.net]
  • This explains why depressed individuals may be more susceptible to infection Other Regionalized Functions of the Hypothalamus the lateral hypothalamus is important in increasing appetite; lesions to this area cause a decrease in body weight the medial[brainaacn.org]
Headache
  • Patients with hypothalamic-pituitary lesions generally present with some combination of Symptoms and signs of a mass lesion: headaches, altered appetite, thirst, visual field defects—particularly bitemporal hemianopia or the hemifield slide phenomenon[merckmanuals.com]
  • Other symptoms of a hypothalamic lesion include weight loss or gain, paleness, excessive sweating, tremor or shakiness, irritability, involuntary eye movements, euphoria, headaches that tend to be worse during the morning, and, in children, failure to[123helpme.com]
  • Patients with pituitary apoplexy present with sudden headache, meningeal signs, unilateral or bilateral cavernous sinus syndrome, visual loss, hypotension, and depressed level of consciousness.[brainaacn.org]
  • Women who are postmenopausal will not have obvious symptoms such as these and may first present with headache or loss of vision. Men may also suffer sexual dysfunction as a result of gonadotropin deficiency.[medical-dictionary.thefreedictionary.com]
  • In some cases, the obstruction seemed enough to cause abnormal accumulation of CSF within the ventricles (hydrocephalus). 5 Impaired CSF flow can generate conditions like severe headache, neurological injury or lethargy.[massagemag.com]
Lethargy
  • In some cases, the obstruction seemed enough to cause abnormal accumulation of CSF within the ventricles (hydrocephalus). 5 Impaired CSF flow can generate conditions like severe headache, neurological injury or lethargy.[massagemag.com]
  • […] nervousness, insomnia, weight loss, tremor, excessive sweating, poor temperature regulation, and frequent bowel movements thyroid opthalmopathy – inflammation of orbital tissues proximal muscle weakness, tremor, dyskinesias and dementia Hypothyroidism lethargy[brainaacn.org]
Amenorrhea
  • Case Report Case Report American Journal of Neuroradiology September 2011, 32 (8) E153-E155; DOI: Abstract SUMMARY: This study describes a case of a patient with OSMS who presented with somnolence, periodic fever, memory impairment, and amenorrhea.[ajnr.org]
  • Página 86 - M. (1980): Pregnancies following chronic intermittent (pulsatile) administration of Gn-RH by means of a portable pump ("Zyklomat") - a new approach to the treatment of infertility in hypothalamic amenorrhea. ‎[books.google.es]
  • ., through the sphenoidal sinus, usually by means of pathway through the mouth and/or nose) prolactin secreting adenomas typically cause amenorrhea in women, hypogonadism in men, and galactorrhea, infertility, hair loss, decreased libido, and weight gain[brainaacn.org]
  • […] androgens and estrogens *other areas influence the production of sex hormones thorugh their regulation of anterior pituitary * before puberty * hypothalamic lesions-- may arret sexual development * after puberty * hypothalamic lesion s may result in amenorrhea[quizlet.com]
  • Case 2 A 21-year-old woman was referred for secondary amenorrhea. She had been treated for seven years with DDAVP for DI. Details of the initial investigation were not available.[em-consulte.com]
Sexual Dysfunction
  • Men may also suffer sexual dysfunction as a result of gonadotropin deficiency. In acquired gonadotropin deficiency, both men and women may notice loss of body hair.[medical-dictionary.thefreedictionary.com]
  • Sexual dysfunction caused by gonadotropin deficiency is the most common endocrine complaint in adults. With stalk interruption hyperprolactinemia can occur, and diabetes insipidus is found in approx-imately 25% of patients [ 6,7 ].[journals.lww.com]
Secondary Amenorrhea
  • Case 2 A 21-year-old woman was referred for secondary amenorrhea. She had been treated for seven years with DDAVP for DI. Details of the initial investigation were not available.[em-consulte.com]

Workup

Hyperprolactinemia
  • It is the reason why masses other than adenomas can cause hyperprolactinemia. This is also why an unenhanced MRI scan suffices in a patient with hyperprolactinemia: it is not the size of the microadenoma, but ruling out other pathology that matters.[radiologyassistant.nl]
  • With stalk interruption hyperprolactinemia can occur, and diabetes insipidus is found in approx-imately 25% of patients [ 6,7 ].[journals.lww.com]
  • Rarely, some children have adipsia without a definable structural lesion (essential adipsia). [ 6 , 7, 8 ] A constellation of adipsia, obesity , hyperprolactinemia, and hypothyroidism was reported in one child. [8] In hypodipsia, the exact pathological[emedicine.medscape.com]
  • […] change Disease, diseased - see also Syndrome hypophysis E23.7 pituitary E23.7 (gland) Disorder (of) - see also Disease pituitary gland E23.7 Dysfunction hypophysis E23.7 Lesion (s) (nontraumatic) hypothalamic E23.7 ICD-10-CM Codes Adjacent To E23.7 E22.1 Hyperprolactinemia[icd10data.com]
  • Two years earlier, investigation of impotence had shown mild hyperprolactinemia [prolactin 30 ng/ml (normal range 5-15)] and hypogonadism [total plasma testosterone 2 m g/l (normal range 3-10)].[em-consulte.com]
Abnormal Thyroid Function Test
  • THYROID FUNCTION TEST 47 THYROID DISORDERS OF INFANCY 462 P A RT IV CALCIUM AND BONE METABOLISM 473 MORPHOLOGY OF THE PARATHYROID 51 PARATHYROID HORMONE 497 PHYSIOLOGY OF CALCIUM 52 PARATHYROID HORMONERELATED 512 CLINICAL APPLICATION OF BONE MINERAL[books.google.com]

Treatment

  • They play a vital role in planning and implementing treatment. As a neurosurgeon I am trained in the operative and non- operative diagnosis, management, prevention, and treatment of neurological disorders.[123helpme.com]
  • Rapidly consult with trusted authorities thanks to new expert-opinion treatment strategies and recommendations. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.de]
  • Patient remained seizure free with treatment. Last follow-up was done at about six months since start of therapy.[annalsofian.org]
  • We report a patient with tuberculous meningitis who continued to have persistent fever despite the satisfactory treatment of her tuberculosis.[vivo.med.cornell.edu]
  • (B) Corresponding image 3 weeks after low-dose radiation treatment shows a significant decrease in size of the lesion.21 8. • Fig SK 10-6 Metastasis.[slideshare.net]

Prognosis

  • If removal of the tumor was successful then the patient can expect a positive prognosis regarding recovery rate and expected mortality.[123helpme.com]
  • Prognosis The prognosis for most patients with hypopituitarism is excellent. As long as therapy is continued, many experience normal life spans.[medical-dictionary.thefreedictionary.com]
  • Follow up Follow up of Horner’s syndrome depends on the etiology of Horner’s syndrome Prognosis Prognosis depends on the etiology of Horner’s syndrome AAO, Basic and Clinical Science Course. Section 5: Neuro-ophthalmology, 2015-2016.[eyewiki.aao.org]
  • Growth hormone deficiency in children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism . Eur J Pediatr 1990 ; 149 : 536 –41 Pisaneschi M, Kapoor G.[ajnr.org]
  • Yamakawa K, Shitara N, Genka S, et al.: Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 1989; 24: 568–73. 17.[journals.lww.com]

Etiology

  • We examined an obese 58-year-old patient with a bilateral posterior hypothalamic lesion of unknown etiology. A 24-hour polysomnography revealed a markedly increased total sleep time (17.6 h). During daytime, only 3 continuous wake phases occurred.[ncbi.nlm.nih.gov]
  • A genetic etiology has also been suggested. [14] Gelastic Seizure may also be observed in patients without MRI lesions and with normal neurologic status.[annalsofian.org]
  • Etiology The etiology of Horner’s syndrome varies with the patient age and site of lesion. The etiology remains unknown in 35-40% of cases.[eyewiki.aao.org]
  • Serum levels of pituitary hormones are lower than normal. hypopituitarism Endocrinology A condition characterized by secretion of one or more anterior pituitary or adenohypophyseal hormones Etiology Idiopathic, pituitary tumor, hypothalamic or infundibular[medical-dictionary.thefreedictionary.com]
  • Imaging usually discloses a suprasellar or parasellar location, and certain specific etiologies may be suspected based on typical MR features.[journals.lww.com]

Epidemiology

  • ICD-9 337.9 Epidemiology In a population based study of Horner’s syndrome in the pediatric age group, the incidence of Horner’s syndrome was estimated to be 1.42 per 100 000 patients younger than 19 years, with a birth prevalence of 1 in 6250 for those[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • Gain a state-of-the-art understanding of comprehensive descriptors , integrating endocrine cell ontogeny, hormonal control of growth and maturation processes, and childhood and young adult pathophysiology with maturation and aging processes.[books.google.de]
  • Pathophysiology Horner's syndrome results from a lesion to the sympathetic pathways that supply the head and neck, including the oculosympathetic fibers. Relevant anatomy The pupil is innervated by sympathetic and parasympathetic fibers.[eyewiki.aao.org]
  • Report of a case and review of the literature with a pathophysiological explanation of the precocious sexual syndrome. Arch. Intern. Med., 67:762-792, 1941. 79. Wilber, I. F., Montoya, F., Plotnikoff, N.[jpgmonline.com]

Prevention

  • As a neurosurgeon I am trained in the operative and non- operative diagnosis, management, prevention, and treatment of neurological disorders.[123helpme.com]
  • Primary prevention Prevention strategies depend on the etiology of Horner’s syndrome. These may include prevention of trauma (especially head trauma), control of cardiovascular risk factors and smoking cessation.[eyewiki.aao.org]
  • Prevention There is no known prevention of hypopituitarism, except for prevention of damage to the pituitary/hypothalamic area from injury. Key terms Adenoma — A benign (not threatening or cancerous) tumor that originates in a gland.[medical-dictionary.thefreedictionary.com]
  • Careful history of surgical complications in relatives and identification of other contributing conditions is the best way to detect and prevent malignant hyperthermia.[nba.uth.tmc.edu]
  • Approximately 25% of optic nerve gliomas do not enhance, so a lack of enhancement should not prevent you from making the diagnosis. This is another example of a right-sided optic nerve glioma with enhancement after gadolinium.[radiologyassistant.nl]

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