RESUMO
We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery. The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.
Assuntos
Adenoma/diagnóstico por imagem , Ponte de Artéria Coronária/efeitos adversos , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/etiologia , Neoplasias Hipofisárias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Adenoma/complicações , Idoso , Humanos , Hidrocortisona/uso terapêutico , Masculino , Apoplexia Hipofisária/tratamento farmacológico , Testes de Função Hipofisária , Neoplasias Hipofisárias/complicações , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios XRESUMO
Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.
