Craniopharyngioma or its surgery induces diabetes mellitus. Case report.

A 23-year-old non-diabetic woman presented to our emergency room with progressive headache. She was diagnosed with craniopharyngioma and received tumor resection. Her blood glucose level was within the normal limit before surgery, and she had no family history of diabetes. Three months after the surgery, acute hyperosmolar hyperglycemic state developed. After 4 months of follow-up, her diabetes persisted but improved with oral antidiabetic drugs. This is the third case report of diabetes developing several months after craniopharyngioma tumor resection. The possible mechanisms of cranipharyngioma or its surgery inducing diabetes mellitus are hypothalamic obesity or hypothalamic damage. The degree of hypothalamic damage before the operation is predictive of diabetes development, and blood glucose level monitoring is important for these patients.

Methicillin-resistant Staphylococcus aureus retropharyngeal abscess complicated by a cervical spinal subdural empyema.

Methicillin-resistant Staphylococcus aureus (MRSA) cervical spinal subdural empyema as a result of a retropharyngeal abscess has not been reported previously. We present a 65-year-old male intravenous drug user who developed spinal subdural empyema after an operation for a retropharyngeal abscess. Although imaging diagnosis and follow-up surgery were performed quickly, the neurological outcome was poor. We review the literature on retropharyngeal abscess with intraspinal infection.

Inflammatory mediators of cerebrospinal fluid from patients with spinal cord injury.

BACKGROUND: The guidelines of MP treatment for acute SCI are still under debate. We examined the inflammatory mediators of CSF in patients with SCI and assessed the effect of MP treatment. METHODS: We studied 7 patients with acute SCI at the cervical level and examined the mediators of CSF in patients by cytokine antibody array, ELISA and gelatin zymography. RESULTS: We found that levels of IL-6, IL-8, monocyte chemoattractant protein-1, neutrophil-activating peptide 2, intracellular adhesion molecule-1, soluble Fas, tissue inhibitors of metalloproteinase 1, and matrix metalloproteinases-2 and -9 were upregulated in patients with complete SCI without MP treatment as compared to patients with MP treatments, incomplete SCI, or controls. Nerve growth factor was upregulated in patients with MP treatment. CONCLUSIONS: We suggest that a neuroinflammatory CSF profile after complete SCI could be suppressed with MP treatment via downregulating the expression of various cytokines.

Diabetic ketoacidosis in a patient with acromegaly.

Diabetes mellitus develops in about 10% of acromegalic patients, usually secondary to insulin resistance caused by growth hormone excess. Diabetic ketoacidosis is a result of relative insulin deficiency and is a rare feature of acromegaly. Here, we present one case of this disorder. A 57-year-old man came to the emergency room due to 2 weeks of dizziness. He also had polyuria, polydipsia, nausea, diplopia, blurred vision and dysarthria. His plasma glucose level was 32.06 mmol/L, plasma osmolarity was 322 mOsm/L, arterial pH was 7.30, level of bicarbonates was 18 mmol/L, urine ketones was 4+, and HbA1c was 14.1%. No specific cause for the development of this metabolic derangement could be found. He displayed clinical features of acromegaly during admission, which was confirmed by an elevated growth hormone level and pituitary macroadenoma shown on magnetic resonance imaging. The patient underwent total transsphenoid tumor removal 2 weeks later; plasma glucose levels became normal thereafter.

Symptomatic granular cell tumor of the neurohypophysis.

Symptomatic granular cell tumors of the neurohypophysis or infundibulum are very rare neoplasms which are difficult to diagnose before operation. We report a case of symptomatic granular cell tumor of the neurohypophysis in a 36-year-old woman who had suffered from amenorrhea and general malaise for more than 1 year. No definite visual or neurological deficit was found. Laboratory examination revealed hyperprolactinemia and decrease of other pituitary hormones. T1-weighted magnetic resonance imaging (MRI) revealed an isointense sellar mass with suprasellar extension. Transsphenoidal subtotal tumor removal was performed and pathological examination revealed a granular cell tumor of the neurohypophysis composed of densely packed polygonal cells with abundant eosinophilic, granular cytoplasm. The granules were periodic acid-Schiff-positive and diastase-resistant. Immunohistochemical study showed positive reaction for S-100 protein and antitrypsin antibodies. Electron microscopic examination showed numerous lysosomes in the cytoplasm of tumor cells. The postoperative MRI showed the residual tumor to be just behind the pituitary stalk and that the tumor should arise from the posterior lobe of the pituitary gland. The postoperative course was smooth and there were no sequelae during 30 months of regular follow-up. We believe surgery remains the treatment of choice and even partial removal of the tumor may benefit the patient.

Resection of giant olfactory groove meningioma with extradural devascularization.

A 55-year-old male patient presented with a giant olfactory groove meningioma supplied by both ophthalmic arteries. The tumor was debulked through a bifrontal craniotomy, but the surgery was discontinued because of extensive blood loss. During a second operation, the dura of the frontal base was dissected extradurally before the tumor was removed. The meningeal blood supply was occluded with bipolar coagulation of the epidural meningeal vessels around the crista galli. The highly vascular tumor then was totally removed with considerably less blood loss. The patient's postoperative course was uneventful. Because the ophthalmic artery cannot be embolized preoperatively, the direct extradural approach to the skull base to devascularize the blood supply around the olfactory groove may reduce blood loss and facilitate resection.

Posterior communicating aneurysm with oculomotor nerve palsy: clinical outcome after aneurysm clipping.

AIM: One of the clinical presentations of intracranial aneurysm is unilateral oculomotor nerve palsy (ONP). The most common location is the posterior communicating artery. Surgical clipping and/or endovascular coiling of the aneurysm are the treatments. The aim of this study was to identify the factors that influence the postoperative recovery of patients who have posterior communicating aneurysm with ONP. MATERIAL AND METHODS: We included 13 patients diagnosed at our hospital from 1993 to 2008 with posterior communicating aneurysm with ONP. Ten patients underwent craniotomy to clip the aneurysm; 3 patients refused surgery. RESULTS: Five (50%) patients presented with periorbital pain. Seven (70%) patients had complete ONP recovery with a median recovery time of 58 days. We found that the first recovered component of ONP after clipping was the parasympathetic fibers with a mean recovery time of 4.4 days. Nine patients had a good recovery outcome; one patient died from postoperative vasospasm. There was no significant linear trend in complete recovery rate across palsy symptom periods. However, the palsy symptom period was significant correlated with recovery time. CONCLUSION: Early decompression of the posterior communicating aneurysm yielded satisfactory recovery and ONP can be reversible. In our patients, the first component of oculomotor function to recover was the parasympathetic fibers.