Pituitary apoplexy during pregnancy: a rare, but dangerous headache.

Pituitary apoplexy is a rare endocrine emergency that occurs in a small number of patients with a pituitary tumor. It is a clinical syndrome characterized by the sudden onset of headache, nausea, vomiting, visual impairment, and decreased consciousness, caused by hemorrhage and/or infarction of the pituitary gland. Pituitary apoplexy has very rarely been described during pregnancy, when it is potentially life-threatening to both the mother and the fetus, if unrecognized. Only a few cases have been published to date. The review of the existing literature underlines that pituitary apoplexy, although rare, should be borne in mind when a pregnant woman presents with severe headache and visual defects of sudden onset. After initial management, which includes intravenous glucocorticoid therapy, fluid and electrolyte replacement, the final selection of medical or surgical treatment should result from a multidisciplinary approach involving expert specialists, keeping into account both severity of clinical presentation and gestational week.

Management of "critical" aneurysms of the anterior circulation: technical suggestions.

This paper first goal is to establish what "critical" aneurysm means. We decided to consider as "critical" aneurysms those whose correct clipping-treatment would be particularly difficult; this particular difficulty could concern the malformation intrinsic characteristics as well as extrinsic factors (the patient's clinical conditions as well as insufficient organizational or technical facilities). We thus reviewed 277 aneurysms operated in the Neurosurgical Department of Varese from 1988 to 1994. We excluded 18 vertebro-basilar system aneurysms; the clinical and surgical charts of the 259 remaining aneurysms were reviewed and informations regarding their last clinical conditions were gathered. In this way it was possible for us to distinguish different categories of critical aneurysms: critical for their anatomical position, morphology, size and for their number; unpredictably critic aneurysms and aneurysms associated with the patient's critical conditions were also considered. After describing our technical solutions and those suggested by the current literature we concluded that what is required to treat these critical aneurysms is not an extraordinary surgical skill, but a good organizational and technical facility at the surgical-team's disposal.