Pituitary apoplexy differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 89: | Line 89: | ||
|[[MRI]] | |[[MRI]] | ||
| | | | ||
* [[CT]] scan without [[Contrast medium|contrast]] is the initial test of choice. [[Pituitary hemorrhage|Pituitary hemorrhag]]<nowiki/>e on [[CT]] presents as a hyper-dense lesion | * [[CT]] scan without [[Contrast medium|contrast]] is the initial test of choice. [[Pituitary hemorrhage|Pituitary hemorrhag]]<nowiki/>e on [[CT]] presents as a hyper-dense lesion | ||
* [[MRI]] is done in cases of inconclusive [[CT]]. An [[MRI]] is more [[Sensitivity (tests)|sensitive]] in identifying [[intrasellar]] mass and [[soft tissue]] changes | * [[MRI]] is done in cases of inconclusive [[CT]]. An [[MRI]] is more [[Sensitivity (tests)|sensitive]] in identifying [[intrasellar]] mass and [[soft tissue]] changes | ||
|[[Blood tests]] may be done to check: | |[[Blood tests]] may be done to check: | ||
* [[PT]]/[[INR]] and [[aPTT]] | * [[PT]]/[[INR]] and [[aPTT]] | ||
| Line 110: | Line 110: | ||
| | | | ||
* 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> | * 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]] | ||
| | | | ||
* [[Lumbar puncture|Lumbar puncture (LP)]] is necessary when there is a strong suspicion of [[subarachnoid hemorrhage]]. LP will show: | * [[Lumbar puncture|Lumbar puncture (LP)]] is necessary when there is a strong suspicion of [[subarachnoid hemorrhage]]. LP will show: | ||
| Line 129: | Line 129: | ||
|[[Lumbar puncture]] for [[CSF]] | |[[Lumbar puncture]] for [[CSF]] | ||
| | | | ||
* [[CT]] scan of the [[head]] may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]] | * [[CT]] scan of the [[head]] may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]] | ||
| | | | ||
* [[Diagnosis]] is based on [[clinical]] presentation in combination with [[CSF]] analysis | * [[Diagnosis]] is based on [[clinical]] presentation in combination with [[CSF]] analysis | ||
* [[CSF]] analysis is the investigation of choice | * [[CSF]] analysis is the investigation of choice | ||
* For more information on [[CSF]] analysis in [[meningitis]] please [[Meningitis#Diagnosis|click here | * For more information on [[CSF]] analysis in [[meningitis]] please [[Meningitis#Diagnosis|click here]] | ||
|- | |- | ||
|[[Cerebral hemorrhage]] | |[[Cerebral hemorrhage]] | ||
|Rapidly progressing [[headache]] | |Rapidly progressing [[headache]] | ||
| | | | ||
* [[ | * [[Nausea]] | ||
* [[Vomiting]] | |||
* [[Diplopia]] | |||
* [[Focal neurologic signs|Focal neurological deficits]] | * [[Focal neurologic signs|Focal neurological deficits]] | ||
| Line 145: | Line 147: | ||
| | | | ||
* [[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]] | ||
| | | | ||
* [[PT]]/[[INR]] and [[aPTT]] should be checked to rule out [[coagulopathy]] | * [[PT]]/[[INR]] and [[aPTT]] should be checked to rule out [[coagulopathy]] | ||
|- | |- | ||
|[[Migraine]] | |[[Migraine]] | ||
| Line 154: | Line 156: | ||
* One-sided | * One-sided | ||
* [[Pulsatility|Pulsating]] | * [[Pulsatility|Pulsating]] | ||
* Lasts between several hours to three days | * Lasts between several hours to three days | ||
| | | | ||
* [[Nausea and vomiting]] | * [[Nausea and vomiting]] | ||
| Line 162: | Line 164: | ||
|'''---''' | |'''---''' | ||
| | | | ||
* [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]] | * [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]] | ||
| | | | ||
* [[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 | ||
|- | |- | ||
|[[Head injury]] ([[Epidural hematoma]]) | |[[Head injury]] ([[Epidural hematoma]]) | ||
| Line 183: | Line 185: | ||
|[[Computed tomography|CT scan]] without [[Contrast medium|contrast]] | |[[Computed tomography|CT scan]] without [[Contrast medium|contrast]] | ||
| | | | ||
* [[Computed tomography|CT scan]] is the first test performed and identifies [[cerebral hemorrhage]] (appears as a hyperattenuating [[clot]]) following [[head injury]] | * [[Computed tomography|CT scan]] is the first test performed and identifies [[cerebral hemorrhage]] (appears as a hyperattenuating [[clot]]) following [[head injury]] | ||
* [[MRI]] is more [[Sensitivity (tests)|sensitive]], takes more time, and is done in patients with [[Symptom|symptoms]] unexplained by [[Computed tomography|CT scan]] | * [[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]] | ||
* The [[Pediatric Glasgow Coma Scale]] is used in young [[children]] | * The [[Pediatric Glasgow Coma Scale]] is used in young [[children]] | ||
|- | |- | ||
|[[Lymphocytic hypophysitis]] | |[[Lymphocytic hypophysitis]] | ||
| Line 201: | Line 203: | ||
* [[Hypopituitarism]] | * [[Hypopituitarism]] | ||
|[[Pituitary]] [[biopsy]] | |[[Pituitary]] [[biopsy]] | ||
|[[CT]] & [[MRI]] typically reveal features of a [[Pituitary gland|pituitary]] [[mass]] | |[[CT]] & [[MRI]] typically reveal features of a [[Pituitary gland|pituitary]] [[mass]] | ||
|The most accurate test is a [[Pituitary gland|pituitary]] [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]] | |The most accurate test is a [[Pituitary gland|pituitary]] [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]] | ||
|- | |- | ||
| rowspan="2" |'''Gradual''' | | rowspan="2" |'''Gradual''' | ||
| Line 215: | Line 217: | ||
|[[MRI]] | |[[MRI]] | ||
| | | | ||
* [[CT]] or [[MRI]] is the initial test to detect intracranial lesions (ring enhancing lesions) | * [[CT]] or [[MRI]] is the initial test to detect intracranial lesions (ring enhancing lesions) | ||
* These [[imaging]] tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]] | * These [[imaging]] tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]] | ||
| | | | ||
* [[Biopsy]] of the [[lesion]] may be done to identify the nature of the lesion such as: | * [[Biopsy]] of the [[lesion]] may be done to identify the nature of the lesion such as: | ||
| Line 235: | Line 237: | ||
|[[Digital subtraction angiography]] | |[[Digital subtraction angiography]] | ||
| | | | ||
* The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating [[thrombus]] in the occluded [[sinus]] | * The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating [[thrombus]] in the occluded [[sinus]] | ||
* [[CT]] and [[MRI]] may identify [[Cerebral edema]] and [[venous]] [[infarction]] may be apparent | * [[CT]] and [[MRI]] may identify [[Cerebral edema]] and [[venous]] [[infarction]] may be apparent | ||
| | | | ||
* 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]] | * 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]] | ||
* [[Cerebral angiography]] may demonstrate smaller clots, and obstructed [[veins]] may give the "corkscrew appearance | * [[Cerebral angiography]] may demonstrate smaller clots, and obstructed [[veins]] may give the "corkscrew appearance" | ||
|} | |} | ||
Revision as of 20:29, 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 (Epidural hematoma) |
|
|
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.