Philip Kane

Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases

Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983–2004. Results: Forty-five patients (28 men; mean age 49 years, range 16–72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1–121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. Conclusions: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage.

Osteochondroma of the rib: An unusual cause of paraparesis

A case of extradural spinal cord compression secondary to invasion of the spinal canal by a costal osteochondroma is reported. The literature relating to osteochondromas of the thoracic region is reviewed.

‘Surgical’ causes of benign intracranial hypertension

Summary Benign intracranial hypertension is a clinical diagnosis linked to a number of medical and surgical disorders. A common aetiology has not yet been established. It would seem, however, that many, if not all, of these cases can be related to some degree of cerebral venous outflow obstruction. We present here a series of patients with extraluminal compression of the cerebral venous sinuses that has been amenable to surgical resection. These ‘surgical’ causes of BIH illustrate an important subset of the disease and inform us about the possible pathophysiological principles underlying the disorder.

Abscess formation within a Rathke's cleft cyst.

We report and discuss the rare case of a pituitary abscess forming within a Rathkes cleft cyst (RCC). A 66-year-old gentleman presented with visual deterioration and symptoms suggestive of hypopituitarism. The patient underwent transsphenoidal debulking of the lesion whereupon purulent material was discovered. Histological examination was suggestive of RCC together with numerous neutrophils characteristic of abscess. Microbiological culture of the material grew Staphylococcus aureus. The patient was treated for a RCC abscess and received antibiotics and endocrine replacement therapy. The patient has been followed up for 2 years without recurrence. Although uncommon, we recommend the consideration of RCC abscess as a differential diagnosis of a pituitary mass lesion as clinical presentation and radiological assessment are not specific in identifying these lesions preoperatively.

De novo meningioma arising at a previous burr hole site

A case of meningioma that developed at a site of a previously performed burr hole is reported. To the best of our knowledge, this is the first reported case of a meningioma arising at a previous burr hole site. The possible reasons for its causation are discussed.

Primitive neuroectodermal tumour presenting with subarachnoid haemorrhage

We report a case of medulloblastoma presenting as subarachnoid haemorrhage in an adult. The literature relating to subarachnoid haemorrhage and intracranial tumour is reviewed.