Pituitary apoplexy differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 65: | Line 65: | ||
| doi = 10.1111/aas.12927 | | doi = 10.1111/aas.12927 | ||
| pmid = 28635146 | | pmid = 28635146 | ||
}}</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> | }}</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><ref name="pmid11779895">{{cite journal |vauthors=Kidwell CS, Saver JL, Villablanca JP, Duckwiler G, Fredieu A, Gough K, Leary MC, Starkman S, Gobin YP, Jahan R, Vespa P, Liebeskind DS, Alger JR, Vinuela F |title=Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application |journal=Stroke |volume=33 |issue=1 |pages=95–8 |year=2002 |pmid=11779895 |doi= |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 109: | Line 109: | ||
|[[Digital subtraction angiography]] | |[[Digital subtraction angiography]] | ||
| | | | ||
* The [[modality]] of choice for [[diagnosis]] of [[subarachnoid hemorrhage]] is | * The [[modality]] of choice for [[diagnosis]] of [[subarachnoid hemorrhage]] is non-contrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup> | ||
* [[Computed tomography|CT]] shows hyperattenuating material filling the [[subarachnoid space]]. | * [[Computed tomography|CT]] shows hyperattenuating material filling the [[subarachnoid space]]. | ||
| | | | ||
| Line 140: | Line 140: | ||
* [[Symptoms]] of [[increased intracranial pressure]] (ICP) | * [[Symptoms]] of [[increased intracranial pressure]] (ICP) | ||
* | * [[Focal neurologic signs|Focal neurological deficits]] | ||
|[[CT]] without [[Contrast medium|contrast]] | |[[CT]] without [[Contrast medium|contrast]] | ||
(differentiates [[ischemic stroke]] from [[hemorrhagic stroke|hemorrhagic stroke]]) | (differentiates [[ischemic stroke]] from [[hemorrhagic stroke|hemorrhagic stroke]]) | ||
| | | | ||
* [[CT]] is highly [[Sensitivity (tests)|sensitive]] for identifying acute [[hemorrhage]] which appears as a hyperattenuating clot. | * [[CT]] is highly [[Sensitivity (tests)|sensitive]] for identifying acute [[hemorrhage]] which appears as a hyperattenuating [[clot]]. | ||
* Gradient echo and T2 susceptibility-weighted [[MRI]] are as [[Sensitivity (tests)|sensitive]] as [[CT]] for detection of acute [[hemorrhage]] and are more [[Sensitivity (tests)|sensitive]] for identification of prior [[hemorrhage]]. | * Gradient echo and T2 susceptibility-weighted [[MRI]] are as [[Sensitivity (tests)|sensitive]] as [[CT]] for detection of acute [[hemorrhage]] and are more [[Sensitivity (tests)|sensitive]] for identification of prior [[hemorrhage]]. | ||
| | | | ||
| Line 153: | Line 153: | ||
* Severe to moderate [[headache]] | * Severe to moderate [[headache]] | ||
* One-sided | * One-sided | ||
* Pulsating | * [[Pulsatility|Pulsating]] | ||
* Lasts between several hours to three days. | * Lasts between several hours to three days. | ||
| | | | ||
| Line 165: | Line 165: | ||
| | | | ||
* [[Migraine]] is a clinical [[diagnosis]] that does not require any [[laboratory]] tests. | * [[Migraine]] is a [[clinical]] [[diagnosis]] that does not require any [[laboratory]] tests. | ||
* [[Laboratory]] tests may be ordered to rule out any suspected coexistent [[metabolic]] problems. | * [[Laboratory]] tests may be ordered to rule out any suspected coexistent [[metabolic]] problems. | ||
|- | |- | ||
| Line 183: | Line 183: | ||
|[[CT]] scan without [[Contrast medium|contrast]] | |[[CT]] scan without [[Contrast medium|contrast]] | ||
| | | | ||
* [[CT]] | * [[Computed tomography|CT scan]] is the first test performed and identifies [[cerebral hemorrhage]] (appears as a hyperattenuating [[clot]]) following [[head injury]]. | ||
* [[MRI]] is more sensitive, takes more time, and is done in patients with [[Symptom|symptoms]] unexplained by [[Computed tomography|CT]] | * [[MRI]] is more [[Sensitivity (tests)|sensitive]], takes more time, and is done in patients with [[Symptom|symptoms]] unexplained by [[Computed tomography|CT scan]]. | ||
| | | | ||
* The [[Glasgow Coma Scale]] is a tool for measuring degree of [[unconsciousness]] and is a useful tool for determining severity of [[injury]]. | * The [[Glasgow Coma Scale]] is a tool for measuring degree of [[unconsciousness]] and is a useful tool for determining severity of [[injury]]. | ||
Revision as of 18:25, 1 September 2017
|
Pituitary apoplexy Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pituitary apoplexy differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Pituitary apoplexy differential diagnosis |
|
Risk calculators and risk factors for Pituitary apoplexy differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
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, and lymphocytic hypophysitis.
Differentiating Pituitary apoplexy From Other Diseases
Pituitary apoplexy should be differentiated from other diseases causing severe headache for example: [1][2][3][4][5][6][7][8][9][10][11]
| Onset | Disease | Symptoms | Gold Standard
Test |
CT/MRI Findings | Other Investigation Findings | |
|---|---|---|---|---|---|---|
| Headache
Characteristics |
Associated Features | |||||
| Sudden | Pituitary apoplexy | Severe headache |
|
MRI |
|
Blood tests may be done to check: |
| Subarachnoid hemorrhage |
|
Digital subtraction angiography |
|
| ||
| Meningitis | Headache is associated with: | Lumbar puncture for CSF |
|
| ||
| Cerebral hemorrhage | Rapidly progressing headache |
|
CT without contrast
(differentiates ischemic stroke from hemorrhagic stroke) |
|
| |
| Migraine |
|
--- |
| |||
| Head injury |
|
|
CT scan without contrast |
|
| |
| Lymphocytic hypophysitis |
|
|
Pituitary biopsy | CT & MRI typically reveal features of a pituitary mass. | The most accurate test is a pituitary biopsy which will show lymphocytic infiltration. | |
| Gradual | Intracranial mass | Morning headache | MRI |
|
||
| Intracranial venous thrombosis |
|
|
Digital subtraction angiography |
|
| |
References
- ↑ Endrit Ziu & Fassil Mesfin (2017). "Subarachnoid Hemorrhage". PMID 28722987.
- ↑ Benedikt Schwermer, Daniel Eschle & Constantine Bloch-Infanger (2017). "[Fever and Headache after a Vacation in Thailand]". Deutsche medizinische Wochenschrift (1946). 142 (14): 1063–1066. doi:10.1055/s-0043-106282. PMID 28728201.
- ↑ Otto Rapalino & Mark E. Mullins (2017). "Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies". Neurosurgery. doi:10.1093/neuros/nyx201. PMID 28575459.
- ↑ I. B. Komarova, V. P. Zykov, L. V. Ushakova, E. K. Nazarova, E. B. Novikova, O. V. Shuleshko & M. G. Samigulina (2017). "[Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]". Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 117 (3. Vyp. 2): 11–19. doi:10.17116/jnevro20171173211-19. PMID 28665364.
- ↑ Sanjay Konakondla, Clemens M. Schirmer, Fengwu Li, Xiaogun Geng & Yuchuan Ding (2017). "New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments". Aging and disease. 8 (2): 136–148. doi:10.14336/AD.2016.0915. PMID 28400981.
- ↑ Priyanka Yadav, Alec L. Bradley & Jonathan H. Smith (2017). "Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey". Headache. doi:10.1111/head.13133. PMID 28653369.
- ↑ S. Wulffeld, L. S. Rasmussen, B. Hojlund Bech & J. Steinmetz (2017). "The effect of CT scanners in the trauma room - an observational study". Acta anaesthesiologica Scandinavica. 61 (7): 832–840. doi:10.1111/aas.12927. PMID 28635146.
- ↑ Johnston PC, Chew LS, Hamrahian AH, Kennedy L (2015). "Lymphocytic infundibulo-neurohypophysitis: a clinical overview". Endocrine. 50 (3): 531–6. doi:10.1007/s12020-015-0707-6. PMID 26219407.
- ↑ Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (2017). "Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours". Nat Rev Neurol. 13 (1): 52–64. doi:10.1038/nrneurol.2016.185. PMID 27982041.
- ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.
- ↑ Kidwell CS, Saver JL, Villablanca JP, Duckwiler G, Fredieu A, Gough K, Leary MC, Starkman S, Gobin YP, Jahan R, Vespa P, Liebeskind DS, Alger JR, Vinuela F (2002). "Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application". Stroke. 33 (1): 95–8. PMID 11779895.