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| __NOTOC__ | | __NOTOC__ |
| | | {{Pituitary apoplexy}} |
| {{CMG}}; {{AE}} {{Akshun}} | | {{CMG}} {{AE}} {{Akshun}} |
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| ==Overview== | | ==Overview== |
| Pituitary apoplexy must be differentiated from other diseases that cause severe headache such as subarachnoid hemorrhage, meningitis, intracranial mass, cerebral hemorrhage, cerebral infarction, intracranial venous thrombosis, migraine, head injury, lymphocytic hypophysitis and radiation injury. | | Pituitary [[apoplexy]] is most commonly caused by [[bleeding]] due to a noncancerous [[tumor]] of the [[pituitary]]. When this bleeding occurs in a woman during or immediately after childbirth, it is called [[Sheehan syndrome]]. |
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| ==Differentiating Pituitary apoplexy From Other Diseases== | | ==References== |
| Pituitary apoplexy should be differentiated from other diseases causing severe headache for example: <ref>{{Cite journal
| | {{reflist|2}} |
| | author = [[Endrit Ziu]] & [[Fassil Mesfin]]
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| | title = Subarachnoid Hemorrhage
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| | year = 2017
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| | pmid = 28722987
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| }}</ref><ref>{{Cite journal
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| | author = [[Benedikt Schwermer]], [[Daniel Eschle]] & [[Constantine Bloch-Infanger]]
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| | title = [Fever and Headache after a Vacation in Thailand]
| |
| | journal = [[Deutsche medizinische Wochenschrift (1946)]]
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| | volume = 142
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| | issue = 14
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| | pages = 1063–1066
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| | year = 2017
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| | doi = 10.1055/s-0043-106282
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| | pmid = 28728201
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| }}</ref><ref>{{Cite journal
| |
| | author = [[Otto Rapalino]] & [[Mark E. Mullins]]
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| | title = Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies
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| | journal = [[Neurosurgery]]
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| | year = 2017
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| | doi = 10.1093/neuros/nyx201
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| | pmid = 28575459
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| }}</ref><ref>{{Cite journal
| |
| | author = [[I. B. Komarova]], [[V. P. Zykov]], [[L. V. Ushakova]], [[E. K. Nazarova]], [[E. B. Novikova]], [[O. V. Shuleshko]] & [[M. G. Samigulina]]
| |
| | title = [Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]
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| | journal = [[Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova]]
| |
| | volume = 117
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| | issue = 3. Vyp. 2
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| | pages = 11–19
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| | year = 2017
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| | doi = 10.17116/jnevro20171173211-19
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| | pmid = 28665364
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| }}</ref><ref>{{Cite journal
| |
| | author = [[Sanjay Konakondla]], [[Clemens M. Schirmer]], [[Fengwu Li]], [[Xiaogun Geng]] & [[Yuchuan Ding]]
| |
| | title = New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments
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| | journal = [[Aging and disease]]
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| | volume = 8
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| | issue = 2
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| | pages = 136–148
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| | year = 2017
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| | doi = 10.14336/AD.2016.0915
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| | pmid = 28400981
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| }}</ref><ref>{{Cite journal
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| | author = [[Priyanka Yadav]], [[Alec L. Bradley]] & [[Jonathan H. Smith]]
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| | title = Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey
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| | journal = [[Headache]]
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| | year = 2017
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| | doi = 10.1111/head.13133
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| | pmid = 28653369
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| }}</ref><ref>{{Cite journal
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| | author = [[S. Wulffeld]], [[L. S. Rasmussen]], [[B. Hojlund Bech]] & [[J. Steinmetz]]
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| | title = The effect of CT scanners in the trauma room - an observational study
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| | journal = [[Acta anaesthesiologica Scandinavica]]
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| | volume = 61
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| | issue = 7
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| | pages = 832–840
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| | year = 2017
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| | doi = 10.1111/aas.12927
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| | pmid = 28635146
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| }}</ref><ref>{{cite journal |vauthors=Johnston PC, Chew LS, Hamrahian AH, Kennedy L |title=Lymphocytic infundibulo-neurohypophysitis: a clinical overview |journal=Endocrine |volume=50 |issue=3 |pages=531–6 |year=2015 |pmid=26219407 |doi=10.1007/s12020-015-0707-6 |url=}}</ref><ref>{{cite journal |vauthors=Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S |title=Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours |journal=Nat Rev Neurol |volume=13 |issue=1 |pages=52–64 |year=2017 |pmid=27982041 |doi=10.1038/nrneurol.2016.185 |url=}}</ref><ref name="pmid9541295">{{cite journal| author=Sato N, Sze G, Endo K| title=Hypophysitis: endocrinologic and dynamic MR findings. | journal=AJNR Am J Neuroradiol | year= 1998 | volume= 19 | issue= 3 | pages= 439-44 | pmid=9541295 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9541295 }} </ref>
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| {| class="wikitable"
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| ! rowspan="2" |Disease
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| ! rowspan="2" |Symptoms
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| ! colspan="2" |Diagnosis
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| |-
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| !CT/MRI
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| !Other Investigation Findings
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| |[[Subarachnoid hemorrhage]]
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| * [[Headache|Severe headache]] (as a worst headache of the life)
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| ** Headache is the main symptom (often starts suddenly and starts after a popping or snapping feeling in the head)
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| * [[Double vision]]
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| * [[Nausea]] and [[vomiting]]
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| * Symptoms of [[meningeal irritation]]
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| * Sudden [[Loss of consciousness|decreased level of consciousness]]
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| * Rapid progression of symptoms
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| * The modality of choice for diagnosis of [[subarachnoid hemorrhage]] is noncontrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup>
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| * [[Lumbar puncture|Lumbar puncture (LP)]] is necessary when there is a strong suspicion of [[subarachnoid hemorrhage]].
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| |[[Meningitis]]
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| * [[Headache]]
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| * [[Neck stiffness]]
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| * [[Fever]]
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| * [[Photophobia]] (inability to tolerate bright light)
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| * [[Phonophobia]] (inability to tolerate loud noises)
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| * [[Irritability]], [[altered mental status]] (in small children)
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| * CT scan of the head may be performed before LP to determine the risk of [[herniation]].
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| * Diagnosis is based on clinical presentation in combination with [[CSF]] analysis.
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| * [[CSF]] analysis is the investigation of choice.
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| * For more information on [[CSF]] analysis in meningitis please [[Meningitis#Diagnosis|click here.]]
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| |Intracranial Mass
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| * [[Headache]]
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| * Nausea
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| * Vomiting
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| * Change in mental status
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| * [[Seizures]]
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| * Focal symptoms of brain damage
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| * Associated co-morbid conditions like [[tuberculosis]], etc
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| * CT or MRI is the initial test to detect intracranial lesions.
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| * These imaging tests determine the location of intracranial mass lesion(s) and help in guiding therapy.
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| * [[Biopsy]] of the lesion is needed to identify the nature of the lesion.
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| ** [[Tumor]]
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| ** [[Abscess]]
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| * X- ray of the skull is a non specific test, but useful if any of the lesions are [[Calcified lesion|calcified]].
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| |[[Cerebral hemorrhage]]
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| * [[Headache]], vomiting, and depressed level of [[consciousness]] from [[increased intracranial pressure]] (ICP)
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| * Progression of focal neurological deficits over periods of hours
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| * [[CT scan]] without contrast is the initial test performed to diagnose [[ischemic stroke]] and rule out [[hemorrhagic stroke]]
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| * [[CT]] is very sensitive for identifying acute [[hemorrhage]] and is considered the gold standard.
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| * Gradient echo and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
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| * PT/ INR and aPTT should be checked to rule out [[coagulopathy]].
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| |[[Cerebral]] [[Infarction]]
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| |The symptoms of an [[ischemic stroke]] vary widely depending on the site and blood supply of the area involved. For more information on symptoms of [[ischemic stroke]] based on area involved please [[Ischemic stroke#Diagnosis#History and symptoms|click here.]]
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| * [[CT scan]] without contrast is the initial test performed to diagnose [[ischemic stroke]] and rule out [[hemorrhagic stroke]].
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| * MR diffusion weighted imaging is the most sensitive and specific test for diagnosing [[ischemic stroke]] and may help detect presence of [[infarction]] in few minutes of onset of symptoms.
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| * [[Carotid]] [[doppler]] may be done to check for patency of carotid arteries and blood supply to the brain.
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| * Cerebral [[angiogram]] is an invasive test and detect abnormalities of the blood vessels, including narrowing, blockage, or malformations (such as [[Aneurysm|aneurysms]] or arterio-venous malformations).
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| |[[Intracranial venous thrombosis]]
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| * [[Headache]]: It is a common presentation (present in 90% of cases); it tends to worsen over a period of several days, but may also develop suddenly ([[thunderclap headache]]).<sup>[[Cerebral venous sinus thrombosis history and symptoms#cite note-Stam2005-1|[1]]]</sup> The headache may be the only symptom of cerebral venous sinus thrombosis.<sup>[[Cerebral venous sinus thrombosis history and symptoms#cite note-Cumurciuc2005-2|[2]]]</sup>
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| * Inability to move one or more limbs
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| * Weakness on one side of the face
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| * [[Aphasia]]
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| * [[Seizure|Seizures]]: 40% of all patients have seizure.
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| * [[Coma|Depressed level of consciousness]] and otherwise unexplained changes in [[mental status]] are common symptoms in the elderly.<sup>[[Cerebral venous sinus thrombosis history and symptoms#cite note-4|[4]]]</sup>
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| * The classic finding of sinus thrombosis on unenhanced CT images is a hyperattenuating thrombus in the occluded sinus.
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| * CT and MRI may identify [[Cerebral edema]] and venous infarction may be apparent.
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| * [[CT]] [[venography]] detects the thrombus, computed tomography with radiocontrast in the venous phase (CT venography or CTV) has a detection rate that in some regards exceeds that of MRI.
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| * [[Cerebral angiography]] may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance".
| | [[Category:Needs content]] |
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| | [[Category:Emergency medicine]] |
| |[[Migraine]]
| | [[Category:Endocrinology]] |
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| | [[Category:Neurology]] |
| * Severe or moderate [[headache]] (which is often one-sided and pulsating) lasts between several hours to three days.
| | [[Category:Obstetrics]] |
| * Other symptoms include gastrointestinal upsets, such as nausea and vomiting, and a heightened sensitivity to bright lights ([[photophobia]]) and noise ([[phonophobia]]). Approximately one third of people who experience migraine get a preceding [[Aura (symptom)|aura]].<sup>[[Migraine overview#cite note-4|[4]]]</sup>
| | [[Category:Disease]] |
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| * CT and MRI may be needed to rule out other suspected possible causes of headache.
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| |[[Migraine]] is a clinical diagnosis that does not require any laboratory tests. Laboratory tests can be ordered to rule out any suspected coexistent metabolic problems or to determine the baseline status of the patient before initiation of [[migraine]] therapy.
| | {{WH}} |
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| | {{WS}} |
| |[[Head injury]]
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| * [[Headache]]
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| * [[Confusion]]
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| * [[Drowsiness]]
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| * Personality change
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| * [[Seizure|Seizures]]
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| * [[Nausea]] and [[vomiting]]
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| * [[Headache|Loss of consciousness]]
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| * A [[lucid interval]], during which a patient appears conscious only to deteriorate later
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| * CT scan is the first test performed and checks for [[cerebral hemorrhage]] following head injury. CT scan is also less time consuming.
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| * MRI is more sensitive, takes more time and is done in patients with symptoms unexplained by CT.
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| * The [[Glasgow Coma Scale]] is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury.
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| * The [[Pediatric Glasgow Coma Scale]] is used in young children.
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| |[[Lymphocytic hypophysitis]]
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| |[[Lymphocytic hypophysitis]] is most often seen in late pregnancy or the [[postpartum]] period with the following symptoms:
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| * [[Hypopituitarism]]
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| * Mass lesion effect such as [[headache]] or [[Visual field defect|visual field defects]]
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| * CT & MRI typically reveal features of a pituitary mass.
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| * The most accurate test is pituitary [[biopsy]] which will show lymphocytic infiltration.
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| |[[Radiation injury]]
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| * [[Headache]]
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| * Impairment of mental function is the most prominent feature such as personality change, impairment of memory, confusion, learning difficulties.
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| * Focal neurological abnormalities and evidence of raised intracranial pressure.
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| CT & MRI will show
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| * Focal radiation [[necrosis]]
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| * Diffuse [[white matter]] injury
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| * Contrast-enhancing mass surrounded by edema and mass effect.
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| |PET scan
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| * Radiation necrosis is hypo metabolic and will have decreased uptake of [[fluorodeoxyglucose]].
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| |}
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| ==References==
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| {{Reflist|2}} | |