Presentation
However, all 13 cases of the pathologically documented SCO presented as combined intra- and suprasellar lesions. Thus it is unlikely that a lesion presenting as a purely intra- or suprasellar mass on imaging is a SCO. [ajnr.org]
Suprasellar masses present with a variety of neurologic or endocrine dysfunctions depending on their site of origin and mass effect on adjacent structures. [tuftsmedicalcenter.org]
Though most suprasellar GCTs conform to these findings, a few reports of mixed GCTs presenting with oculomotor or abducens palsy have been reported. [4], [5], [6], [7] Our report adds two more cases to such unusual clinical presentation. [neurologyindia.com]
Eleven patients (47.8%) presenting with bifocal GCTs exhibited tumor seeding at presentation. Tumor seeding was significantly associated with bifocal lesions (p < 0.001). [neurosurgery-blog.com]
This unusual presentation is discussed and plausible hypotheses are given. [ncbi.nlm.nih.gov]
Entire Body System
- Pain
Symptoms strongly suggesting metastasis in the parasellar or sellar space include painful ophthalmoplegia in association with the sudden onset of DI [10, 26, 34, 42]. The pain may be retro-orbital or may be due to trigeminal dysfunction [43–45]. [hindawi.com]
This report highlights an unusual nonexpansile cause of acute and painful complete oculomotor palsy. [oatext.com]
The ocular manifestations included visual loss in 59 (86%), eye pain in six (9%), diplopia in three (4%), and ptosis in one (1%) patient. [jmatonline.com]
[…] and Neurophysiology Neuroanesthesia and Critical Care Neurobiology Neuroendoscopy Neuromonitoring Neuro-oncology Neuropathology Neuropsychiatry Neuroscience Nursing Neurosurgery Concepts Neurosurgical Developments on the Horizon Neurovascular Outcomes Pain [surgicalneurologyint.com]
[…] on endovascular neuroradiology, parkinsonian syndromes, Lewy body dementias, frontotemporal dementia, vanishing white matter, vasculitis, normal pressure hydrocephalus, neuromyelitis optica, Kennedy disease, spinal muscular atrophy, complex regional pain [books.google.es]
- Fatigue
Patient 2 – A 49-year-old woman was admitted to hospital because of intensive headache, fatigue, vertigo and visual deficit. Magnetic resonance showed an expansive process within sellar region extending to the adjacent cavernous sinus. [bib.irb.hr]
[…] surgery or trauma Past Medical History: Hypothyroidism Medications: Levothyroxine Family History: Negative for cancer or ocular disease Social History: Machinist, longtime smoker Review of Systems: Negative, including no weight change, mood change, fatigue [webeye.ophth.uiowa.edu]
Pituitary tumors may damage healthy hormone-producing cells, causing a lack of certain hormones and symptoms including fatigue, weakness, growth problems, and disruption of sexual processes. [columbianeurosurgery.org]
This frequently results in one or more of the following: growth failure, delayed puberty, loss of normal menstrual function or sexual desire, increased sensitivity to cold, fatigue, constipation, dry skin, nausea, low blood pressure, and depression. [pituitary.org]
For GCT, the next most common symptoms were headache (21/64), amenorrhea (12/64), fatigue (8/64), and memory loss (7/64). Table 3: Presenting symptoms for pituicytoma, SCO, and GCT DI was especially uncommon with these tumors. [ajnr.org]
- Infertility
Four had oligomenorrhea with or without galactorrhea, one had amenorrhea with galactorrhea, and two complained of infertility. [ncbi.nlm.nih.gov]
Prolactin: Infertility. Amenorrhea. Galactorrhea. ACTH: Excess secretion of ACTH causes all the features of the Cushing’s syndrome. Hyposecretion. 10. [slideshare.net]
- Other means of revelation: o Intracranial hypertension syndrome. o Hormonal troubles. o Vision troubles. o Hyperprolactinemia. o Galactorrhea-amenorrhea. o Primary infertility. o Acromegalia. o Epilepsy. o Cushing syndrome. [posterng.netkey.at]
An excess of hormones can cause a wide range of effects that depend on the hormone, such as infertility, abnormal growth, high blood pressure, unusual changes in the skin and body, and specific growth disorders. [columbianeurosurgery.org]
A prolactinoma is the most common pituitary tumor and may cause amenorrhea, irregular periods, galactorrhea, infertility in women and osteoporosis. It may cause hypogonadism, loss of libido, and impotence in men. [emedicine.medscape.com]
- Pseudotumor
We describe here five women, 21-38 yr old, all suspected of having a PRL-secreting adenoma because of a pseudotumoral appearance of the pituitary on computerized tomographic (CT) scan or magnetic resonance imaging (MRI). [ncbi.nlm.nih.gov]
Orbital inflammations Methysergide for prevention of headache Pseudotumor of the orbit and retroperitoneal fibrosis Multisystem fibrosis in alphalantitrypsin deficiency [semanticscholar.org]
[…] hematopoietic lesions: primary CNS lymphoma secondary CNS lymphoma posttransplant lymphoproliferative disorders anaplastic large cell angiotropic diffuse large B cell lymphoma Erdheim-Chester disease histiocytic lymphoma/sarcoma Hodgkin inflammatory pseudotumor [pathologyoutlines.com]
[…] which the cause is unknown (idiopathic), or as a secondary disorder, in which it occurs due to an underlying condition or disorder such as a treated pituitary tumor, head trauma, or a condition known as idiopathic intracranial hypertension (also called pseudotumor [rarediseases.org]
Inflammatory pseudotumors etiologies (neurohypophysitis, histiocytosis, sarcoidosis ...) are suprasellar with enlargement of the stalk and often with diabetes insipidus (questioning the possibility of the diagnosis of an adenoma) (Figures 13). [neurochirurgica.org]
- Sepsis
Suprasellar pathology Pituitary abscesses can occur as sequelae of sepsis, extension of sinusitis, sphenoid osteomyelitis, cavernous sinus thrombophlebitis and meningitis. [appliedradiology.com]
The causes of death in these patients were hypothalamic dysfunction, sepsis and respiratory failure. Late complications: Nineteen (40%) patients were found to have hypopituitarism and required hormonal replacement postoperatively. [neurologyindia.com]
They may occur in isolation, in association with a local and/or regional intracranial infection, or in systemic sepsis in an immunocompromised patient. [pubs.rsna.org]
CNS Infections Infectious meningitis, such as sepsis, bacterial meningitis, and tuberculous meningitis (TBM) and non-infectious conditions, such as autoimmune encephalitis, may result in a number of metabolic alterations, and HN is the most common electrolyte [frontiersin.org]
Respiratoric
- Aspiration
Diagnostic aspiration cytology of sacral chordoma. J Cytol 2007;24:60. 4. Permi HS, Kishan Prasad H, Veena S, Teerthanath S. Presacral chordoma diagnosed by transrectal fine-needle aspiration cytology. J Cytol 2011;28:89-90. [ PUBMED ] 5. [cytojournal.com]
[…] develop before visual defects are noticed Radiotherapy is indicated for treatment of residual tumor or recurrence Occasionally intralesional radiation to control cysts Asymptomatic patients or very small tumors may be monitored with serial MRIs Cyst aspiration [pathologyoutlines.com]
A little quantity of fluid was aspired and sent for analysis. Membranes around the area of the hematoma and resembling to arachnoid are collected. [oatext.com]
Cyst aspiration combined with intracavitary phosphorus-32 ( 32 P) instillation is an alternative to traditional surgical resection (see the video below). [emedicine.medscape.com]
- Hyposmia
Neurological complaints, such as mild mental or motor dysfunction, vertigo, epileptic attack, hyposmia, were present in a much lower degree (from 2.3 to 9.3% of patients) in addition to oculomotor paresis with subjective complaints of diplopia and proptosis [go.galegroup.com]
- Anosmia
Anosmia after anterior communicating artery aneurysm surgery: Comparison between the anterior interhemispheric and basal interhemispheric approaches. Neurosurgery 1996;38:325-8. [ PUBMED ] 4. Suzuki J, Katakura R, Mori T. [neurologyindia.com]
Cardiovascular
- Hypertension
Most cases occur in middle-aged women who are obese and have high blood pressure (hypertension). [rarediseases.org]
Related pathology It is important to review on MRI and CT since obliteration may occur when there is uncal herniation and in cases of severe intracranial hypertension. It can also be filled with blood from subarachnoid hemorrhage. [radiopaedia.org]
- Other means of revelation: o Intracranial hypertension syndrome. o Hormonal troubles. o Vision troubles. o Hyperprolactinemia. o Galactorrhea-amenorrhea. o Primary infertility. o Acromegalia. o Epilepsy. o Cushing syndrome. [posterng.netkey.at]
Literary evidence cites the effective usage of opioids and the above mentioned drugs to attenuate the hypertensive response. [ncbi.nlm.nih.gov]
Skin
- Sweating
Dermoid cysts are bizarre in that they contain developmentally mature skin, complete with sweat glands, hair follicles, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone and cartilage, nails and teeth, and thyroid tissue [upmc.com]
Excessive sweating. (Refer to the PDQ summary on Hot Flashes and Night Sweats for more information.) Dysmorphophobia. [cancer.gov]
Excessive sweating, overproduction of sebum, and thickening of the skin are early subtle changes associated with acromegaly. The manifestations of acromegaly are significant. [glowm.com]
Tumors that elaborate TSH produce signs and symptoms of thyrotoxicosis, such as heat intolerance, sweating, tachycardia, fine tremor, and weight loss. Some tumors may secrete more than one hormone, such as GH and PRL. [emedicine.medscape.com]
Renal losses Diuretic administration Osmotic diuresis Post-obstructive diuresis Polyuric phase of acute tubular necrosis Gastrointestinal losses Vomiting Nasogastric drainage Diarrhea Enterocutaneous fistula Cutaneous losses Burn injuries Excessive sweating [cancertherapyadvisor.com]
- Pruritus
SIDE EFFECTS: bradycardia, hypotension (these side effects may be blunted by pretreatment with anticholinergics), N/V, muscle rigidity, pruritus (especially facial) dose dependent respiratory depression at doses > 0.05 mcg/kg/min. [doctorlib.info]
Musculoskeletal
- Contusion
Four (9%) patients developed subdural effusion and retraction site contusion developed in one (92.2%) patient. [neurologyindia.com]
[…] endocrine and neurosurgery) Differential Diagnosis for Pituitary Adenoma Craniopharyngioma (particularly in children) Parasellar meningioma Parasellar internal carotid artery aneurysm Chiasmal glioma Rarely, sarcoidosis, multiple sclerosis, chiasmal contusion [webeye.ophth.uiowa.edu]
Moro et al. (2007) found that cerebral contusion and acute subdural hematoma are the two main causes of HN caused by TBI, which suggests that more attention is needed to monitor the serum sodium of patients with those two types of TBI. [frontiersin.org]
Eyes
- Diplopia
The ocular manifestations included visual loss in 59 (86%), eye pain in six (9%), diplopia in three (4%), and ptosis in one (1%) patient. [jmatonline.com]
Diplopia indicated a possible tumor mass involving the cavernous sinus. [kjim.org]
Within months of surgery, the patient’s diplopia and movement of her right eye improved. She had no other neurologic complaints. [barrowneuro.org]
However, this effect is seen in any condition that causes delayed optic nerve conduction such as multiple sclerosis and retinal disorders.[25] Diplopia Diplopia may be due to a paretic diplopia from ocular motor cranial nerve (e.g., III, IV, VI) paresis [eyewiki.aao.org]
Visual symptoms and signs include vision loss, diplopia, and multiple cranial nerve palsies secondary to rapid expansion of the tumor into the adjacent cavernous sinuses, with cranial nerve III the most commonly affected. [webeye.ophth.uiowa.edu]
- Vertical Gaze Palsy
This phenomenon is caused by involvement of midbrain structures adjacent to the pineal GCT and is characterised by vertical gaze palsy, nystagmus on convergence and pupillary dilation with poor reactiveness to light. [tandfonline.com]
- Unilateral Proptosis
Ewing's sarcoma of the orbit with intracranial extension: A rare cause of unilateral proptosis. J Pediatr Neurosci 2011;6:36-9. [Full text] 3. Weins AL, Hattab EM. The pathological spectrum of solid CNS metastases in the pediatric population. [ruralneuropractice.com]
Urogenital
- Sexual Dysfunction
Clinical features of Cushing's syndrome Feature Frequency (%) Obesity 92 Moon facies 90 Hypertension 85 Glucose intolerance 80 Menstrual and sexual dysfunction 74 Hirustism and acne 70 Striae 70 Proximal muscle weakness 67 Osteoporosis 55 Easy bruising [glowm.com]
The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. [cancerindex.org]
Chronic administration may have higher incidence of orthostatic hypotension, fever, sexual dysfunction, and hepatic toxicity than other beta blockers. metoprolol (Lopressor®)DRUG INFO Beta blocker that is relatively cardioselective at doses < 200 mg. [doctorlib.info]
Neurologic
- Headache
A 45-year-old man was seen for urgent evaluation of worsening headaches and loss of vision. He first noticed his symptoms 6 months before the onset of recurrent headaches with blurry and blank spots in his vision. [healio.com]
With pituicytomas, the next most common presenting symptoms were headache (10/35), hypopituitarism (9/35), fatigue (8/35), and decreased libido (7/35). For SCO, hypopituitarism was the next most common symptom (6/13) followed by headache (4/13). [ajnr.org]
Headaches associated with Rathke′s cleft cyst. Headache 2006;46:1580-6. 6. Billeci D, Marton E, Tripodi M, Orvieto E, Longatti P. Symptomatic Rathke′s cleft cysts: A radiological, surgical and pathological review. Pituitary 2004;7:131-7. 7. [mjdrdypu.org]
Abstract A case report of ectopic pituitary gland in the suprasellar region of a normal 39-year-old woman with persistent headaches is presented. [ncbi.nlm.nih.gov]
- Stroke
Methods This was a prospective observational study, which included all patients with non-traumatic hemorrhagic stroke... [read.qxmd.com]
Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery. Stroke. 2011;42:2810–2815. [ncbi.nlm.nih.gov]
- Bitemporal Hemianopsia
An examination of her visual fields revealed bitemporal hemianopsia. Her corrected visual acuity with eye glasses was insufficient. [semanticscholar.org]
Physical examinations were normal except bitemporal hemianopsia revealed by ophthalmic examination. Preoperative neuroendocrine examinations showed a mild hyperprolactinemia of 72.3ng/ml (normal range, 2.8 ng/ml-29.2 ng/ml). [path.upmc.edu]
His vision postoperatively showed a persistent bitemporal hemianopsia, but with significant improvement in visual acuity to 20/40 in the right eye and 20/20 in the left eye. [healio.com]
[…] and suprasellar ND Bitemporal hemianopsia + − Transsphenoidal 5 Whee, 11) 2002 39 M Intrasellar and suprasellar ND Bitemporal hemianopsia + − Transsphenoidal 6 Maatens, 5) 2003 33 F Intrasellar and suprasellar ND Left frontal headache, diminished visual [ncbi.nlm.nih.gov]
- Lethargy
Here, we report the case of a 2-year-old male child who presented with lethargy and vomiting. He had features of raised intracranial pressure with reduced vision in both eyes. [asianjns.org]
The next frequent symptoms were headache and generalized lethargy. Diabetes insipidus was a presenting symptom in 4 cases and hydrocephalus was noted in 4 cases preoperatively. [jkns.or.kr]
Typical symptoms include: Headache Nausea/vomiting Lethargy Seizures Mass protrusion in the skull Focal neurological signs secondary to pressure of surrounding structures Developmental delay Suprasellar Cysts ( a variety of Arachnoid Cyst that lie above [neurosurgerydallas.com]
With more severe disturbances in water homeostasis neurologic manifestations ranging from mild lethargy and confusion to severe depression of sensorium may be present. [cancertherapyadvisor.com]
This is a 3-year-old boy who presented with 2 days history of headache, vomiting, lethargy and mild fever without neck rigidity. [clinmedjournals.org]
- Vertigo
Patient 2 – A 49-year-old woman was admitted to hospital because of intensive headache, fatigue, vertigo and visual deficit. Magnetic resonance showed an expansive process within sellar region extending to the adjacent cavernous sinus. [bib.irb.hr]
Marked obstructive hydrocephalus Nest cell positive for GFAP, cytokeratin, & vimentin Second craniotomy for debulking surgery 1.5 yrs after original presentation Negative for desmin immunore-activity Tison et al., 1996 24 yrs, M Headache, vomiting, vertigo [thejns.org]
Neurological complaints, such as mild mental or motor dysfunction, vertigo, epileptic attack, hyposmia, were present in a much lower degree (from 2.3 to 9.3% of patients) in addition to oculomotor paresis with subjective complaints of diplopia and proptosis [go.galegroup.com]
[…] hypothalamus damage clinically present with diabetes insipidus, hypoevolutism and intelligence changing [42,43], and there were four cases; and (6) in the late period of IC, intracranial pressure increases, resulting in headache accompanied by vomiting, vertigo [kundoc.com]
Patients with cerebellar hemangioblastomas typically present with headache, vertigo, ataxia, and ninth cranial nerve palsy; in some cases, polycythemia has been noted given that up to 40% have been reported to secrete erythropoietin [47]. [ajronline.org]
Workup
It is crucial to have a multidisciplinary team approach with baseline and follow up endocrine workup. [abstracts.eurospe.org]
[…] massive MRI: High signal intensity on T1 weighted images Heterogeneous enhancement Fluid levels consistent with cystic components CT: Better than MRI at showing calcifications Laboratory Same for both types of craniopharyngiomas Full pituitary endocrine workup [pathologyoutlines.com]
The clinical workup for CNS germ cell tumors includes examination of cerebrospinal fluid (CSF) and blood for markers of differentiation, specifically β-hCG and α-fetoprotein (AFP). [neupsykey.com]
Initial workup, including CT and MRI of the brain is shown (Fig. 1). [jaocr.org]
Dynamic pituitary MRI has high sensitivity and specificity for the diagnosis of mild Cushing's syndrome and should be part of theinitial workup. Horm Metab Res. 2007;39(6):451-456. Simonetta AB. Imaging of suprasellar and parasellar tumors. [appliedradiology.com]
Treatment
Treatment depends upon the underlying cause but often requires surgical decompression. [tuftsmedicalcenter.org]
It also includes classic radiographic presentations and treatment considerations for each lesion. © The Author(s) 2015. [ncbi.nlm.nih.gov]
However, treatment strategies of adult ATRT may be different from that of pediatric ATRT. [btrt.org]
Is surgery the best path of treatment at this time? Thank you again for your support. M. Montoya, M.D. [endotext.org]
Prognosis
Although rare, pure suprasellar germinomas carry worse prognosis than other locations. [ncbi.nlm.nih.gov]
Treatment and prognosis In general, a biopsy is required as treatment and prognosis will vary with histology (whereas it is independent of location). [radiopaedia.org]
Key words: Prognosis; Visual Acuity; Meningioma; Optic Chiasm; Neurosurgical Procedures; Treatment Outcome; Recovery of Function Uvod. [go.gale.com]
Prognosis A prognosis is an estimate of the likely progress of a disease after a diagnosis, based on an average patient group. [braintumour.ca]
Prognosis is dependent upon the tumor type, the most common of which is a germinoma which has a peak incidence during pubescence. Prognosis for germinomas is generally good with a 10-year survival rate over 90% after radiation therapy. [jaocr.org]
Etiology
In 183 short chapters, the book provides the essentials clinicians need on symptoms/signs, diagnostic tests, and neurologic disorders of all etiologies. For this edition, Timothy A. [books.google.es]
Six major sections cover all topics related to epidemiology and etiology, molecular biology, clinical features and supportive care, imaging, neuroanatomy and neurosurgery, medical oncology and targeted therapies, and radiation oncology for adult and pediatric [books.google.ro]
A malignant etiology should be suspected if osteolysis is present. The presentation may be variable between an enlargement of the pituitary stalk or sellar and suprasellar tumor. [neurochirurgica.org]
LCH is a rare disease of uncertain etiology which typically presents in children under two years of age, is more common in boys, and may involve any organ system. [jaocr.org]
Epidemiology
This is the leading international professional reference text that also serves as a bench book, describing all aspects of the pathology of brain tumours - genetics, molecular biology, epidemiology, morphology, immunohistochemistry, diagnostic criteria [books.google.ro]
Conclusion Pediatric meningioma is an uncommon and sometimes surprising diagnosis given its epidemiologic, histologic, and clinical features. [cnjournal.biomedcentral.com]
We compared the clinical and epidemiological characteristics of bifocal GCTs with those of GCTs located solely in the suprasellar or pineal regions. [thejns.org]
Epidemiology: · Average age: 32 years. · 28 women/15 men. [posterng.netkey.at]
Pathophysiology
It addresses diagnosis, pathophysiology, management and prognosis and is written in a clear, concise style for quick, easy reference in the clinic. [books.google.es]
CNS, SIAD 31 2010 Cerebral salt wasting: pathophysiology, diagnosis, and treatment. --- 32 2010 Characterization of cerebral salt wasting after subarachnoid hemorrhage model induced by endovascular puncture. [allie.dbcls.jp]
SIADH is the biochemical manifestation of a wide variety of diseases, and the pathophysiology of SIADH is sometimes… CONTINUE READING Create an AI-powered research feed to stay up to date with new papers like this posted to ArXiv Figures, Tables, and [semanticscholar.org]
Pathophysiology Hematogenous metastases to this region most frequently go to the pituitary gland, infundibulum, and tuber cinereum, because these structures lie outside the blood-brain barrier. [radiologykey.com]
PATHOPHYSIOLOGY — With respect to pathophysiology, two issues need to be addressed: the mechanism of salt wasting and the mechanism of hyponatremia. The mechanism by which cerebral disease might lead to renal salt wasting is poorly understood. [docsity.com]
Prevention
Extreme caution was taken to avoid spillage of tumor cyst fluid into subarachnoid spaces, in order to prevent chemical meningitis. [neurologyindia.com]
Orbital inflammations Methysergide for prevention of headache Pseudotumor of the orbit and retroperitoneal fibrosis Multisystem fibrosis in alphalantitrypsin deficiency [semanticscholar.org]
The cerebral aqueduct is compressed, preventing CSF circulation and causing it to accumulate in the ventricles. The CSF migrates into the brain tissue as the pressure within the ventricles rises. [anatomicaljustice.com]
It failed to prevent the recurrence or progression of residual tumor in another 5 patients, occurring from 6 to 60 months after irradiation. [clinicalgate.com]
8055-8051-9 (Print) eISBN: 978-3-318-01300-9 (Online) Abstract The principles in the surgical management of sellar and suprasellar tumors are to relieve mass effect, normalize pituitary hypersecretion, preserve or restore normal pituitary function, prevent [karger.com]