Pituitary apoplexy after aortic abdominal aneurysm surgery: a case report.

Pituitary apoplexy (PA) occurring after surgery is a rare but life-threatening acute clinical situation following extensive haemorrhage or necrosis within a pituitary adenoma. Pituitary apoplexy has been reported to occur spontaneously in the majority of cases or in association with various inducing factors. One of the pathophysiological mechanism that has been postulated is the fall of arterial blood pressure inducing ischaemia followed by infarction of the pituitary gland. We report a case of pituitary apoplexy following aortic abdominal surgery. To our knowledge, this has not been previously reported. A 73-year old man complained of headache and diplopia. At clinical examination, he presented a right oculomotor nerve palsy. Magnetic resonance imaging (MRI) showed a haemorrhagic sellar mass. In our case, intraoperative hypotension could have been the precipitating factor. Diagnostic and therapeutic measures are discussed.

[A surgical approach to Holmes' tremor associated with high-frequency synchronous bursts]. / Approche chirurgicale d'un tremblement de Holmes associé à un tremblement synchrone de haute fréquence.

INTRODUCTION: The effectiveness of thalamic stimulation is now clearly demonstrated for essential tremor, but remains to be demonstrated for other types of tremor. OBSERVATION: A young woman presented Holmes' tremor resulting from a pontine tegmental hemorrhage related to an arteriovenous malformation. A surgical approach was considered when major functional impairment persisted at 2-year follow-up despite drug therapy. The patient underwent unilateral thalamic deep brain stimulation (Vim); major improvement persisted at eighteen months follow-up. CONCLUSION: This observation is in line with previous reports suggesting that thalamic surgery can be one of the best options for treating medically intractable Holmes' tremor. The mechanism underlying the tremor, implying dentate-rubro-thalamic pathways is discussed. Moreover, the patient exhibited short periods of 16Hz tremor when her arms were maintained outstretched. Thalamic stimulation also appears to be effective for these high-frequency synchronous cerebellar bursts.

[Isolated idiopathic amyloid tumor of the sacrum. An important differential diagnosis]. / Amyloïdome solitaire idiopathique du sacrum. Un diagnostic différentiel important.

Primary amyloidosis may present as a pseudotumoral mass. Often associated with myeloma or paraproteinemia, it may also be isolated, without preexisting or associated disease. Isolated pseudotumoral bone involvement is rare and especially in the spine. Differential diagnosis is very important, because the prognosis of primary amyloidoma is excellent after surgical removal.

Unusual occurrence of a pseudo-aneurysm of the middle cerebral artery in a patient with fibromuscular dysplasia.

Our patient is the first reported case of pseudo-aneurysm due to the rupture of an intracranial artery in the context of fibromuscular dysplasia (FMD). As we assume that our case is probably not unique, we conclude that this diagnosis may be sometimes overlooked for lack of confirmation either by surgery or autopsy. The retrospective study of the arteriograms suggests some clues that should be taken into account to foresee the existence of an intracranial pseudo-aneurysm in order to avoid unexpected peroperative difficulties: 1.) the rapid growth of the lesion within a few weeks and 2.) the unusual location of the aneurysmal neck at some distance from a arterial bifurcation.

[Frontal sinusitis, palpebral abscess and exophthalmia due to osteoma]. / Sinusite frontale, abcès palpébral et exophtalmie sur ostéome.

Although osteomas of the paranasal sinuses are slowly growing bony benign neoplasms, they can cause very important orbital or neurological complications. A 58 year old man's osteoma with sinusitis, abscess and proptosis is reported. A review of the literature is presented and the importance of CT scanner, to appraise the enlargement of the tumor and so to select the best surgical approach, is defined.

[Angiomas of the epidural space (author's transl)]. / Angiomes de l'espace épidural

The authors describe two cases of angiomas strictly limited to the spinal epidural space. They review the literature and stress the rarity of these tumours.