Ophthalmoplegic migraine with reversible enhancement of intraparenchymal abducens nerve on MRI

We describe a patient with ophthalmoplegic migraine and right abducens nerve palsy, in whom serial magnetic resonance imaging showed a transient, gadolinium-enhancing lesion in the right lower pons, during both headache and the headache-free period. The enhancing linear lesion was felt to represent intraparenchymal fibers of the affected abducens nerve. The possible pathophysiology of this unique finding is discussed.     

MRI Findings in a Case of Ophthalmoplegic Migraine

SYNOPSIS
MRI using gadolinium contrast material can demonstrate lesions in cranial nerves. Tumors and Inflammatory lesions have been described.^1,2 There is little published information on MRI of cranial nerve in patients with migraine headache with ophthalmoplegia.³ We present a case of ophthalmoplegic migraine with a cranial nerve abnormality which was subsequently shown to improve as the patient clinically improved. Implications from this finding are discussed in relation to the pathophysiology of ophthalmoplegic migraine.     

Ophthalmoplegic migraine with alternating unilateral and bilateral internal ophthalmoplegia

We describe a patient with ophthalmoplegic migraine and internal ophthalmoplegia with alternating unilateral involvement and bilateral involvement in whom brain MRI scan showed alternating gadolinium enhancement on the cisternal portion of the oculomotor nerve.     

低场MRI垂体形态改变对垂体腺瘤的诊断价值

目的：在低场MRI检查中垂体形态改变对垂体腺瘤的诊断价值。材料与方法：对32例低场MRI检查中垂体形态发生改变的病例与临床进行对照分析，以评价低场MRI垂体形态改变对垂体腺瘤的诊断价值。结果：32例低场MRI垂体形态发生改变的病例中有27例经证实为垂体腺瘤，阳性率达（84．38％）。说明低场MRI垂体形态改变对垂体腺瘤的诊断有明显敏感性。结论：排除垂体正常生理性变异外，低场MRI垂体形态改变高度支持垂体腺瘤的诊断。     

MRI动态增强对垂体微腺瘤的诊断价值

目的探讨MRI动态增强对垂体微腺瘤诊断的应用价值。方法使用Eclipse1.5T超导磁共振仪,对本组48例经手术病理或临床治疗后证实的垂体微腺瘤先行矢状位及冠状位T1WI成像,然后注入Gd-DTPA行冠状位T1WI动态增强扫描,随之行冠状位T1WI常规延迟FSE序列增强扫描。结果①48例垂体微腺瘤直径均<10mm,平均为5.8mm。36例偏向一侧,占75%;8例位于中心,占21%;4例位于鞍底,占4%。②平扫病变检出率43.7%(21/48);动态增强病变检出率97.9%(47/48);常规延迟增强病变检出率73%(35/48),三者检出率相互比较差异有统计学意义(P<0.005)。结论MRI动态增强扫描能显著提高病变的检出率,对垂体微腺瘤有较高的诊断价值,常规延迟增强扫描是动态增强扫描的必要补充,可避免病变遗漏。     

A Contrast Enhanced Lesion of the III Nerve on MR of a Patient With Ophthalmoplegic Migraine as Evidence for a Tolosa-Hunt Syndrome

SYNOPSIS
A 23-year-old female with a six year history of migraine without aura twice developed a nearly complete internal and external III nerve paresis ipsilateral to her headache, two days after the onset of migraineous headache. An MR scan performed one week after the second episode showed a contrast enhanced lesion of the prepontine III nerve, where it enters the cavernous sinus on the left side. The headache, as well as the paresis ameliorated spontaneously. We suggest this is a further well documented case of "ophthalmoplegic migraine" which might reflect Tolosa-Hunt syndrome.     

垂体柄中断综合征17例临床特点分析

目的： 探讨垂体柄阻断综合征（pituitary stalk interruption syndrome,PSIS）的临床特征。方法： 回顾性分析2009年10月至2019年3月复旦大学附属中山医院内分泌科收治的17例PSIS患者的一般特征、实验室检查和影像学数据。结果： 17例患者中,女性3例（17.65%）,男性14例（82.35%）,发病年龄为（8.12±3.31）岁,病程为（18.59±6.87）年。性腺功能减退17例（100.00%）、生长激素缺乏16例（94.12%）、肾上腺皮质功能减退14例（82.35%）、甲状腺功能减退17例（100.00%）、高泌乳素血症5例（29.41%）、中枢性尿崩症1例（5.88%）。所有患者均合并至少3种垂体前叶激素异常,既往使用性激素、生长激素、糖皮质激素、甲状腺激素替代治疗患者分别为10例、7例、3例、7例。结论： 对生长发育障碍及性腺发育异常患者常规行垂体影像学检查可减少误诊、漏诊。PSIS患者应定期随访,评估垂体前叶、后叶功能,有助于及时诊断、治疗。     

Ophthalmoplegic migraine with reversible thalamic ischemia shown by brain SPECT

Two patients who presented with ophthalmoplegic migraine underwent electroencephalography, brain magnetic resonance imaging, cerebral angiography, and technetium Tc 99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) during an attack. Follow-up SPECT was performed after neurologic symptoms resolved. In both patients, SPECT during an attack of ophthalmoplegia and headache demonstrated significantly decreased regional cerebral blood flow (rCBF) in the thalamus on the side of the ophthalmoplegia; rCBF reverted to normal on a follow-up SPECT during the symptom-free period. These findings suggest reversible ischemia in the territories of perforating branches of the posterior cerebral artery may accompany ophthalmoplegic migraine and possibly bear some relationship to the clinical features.     

Ophthalmoplegic migraine: a case with recurrent palsy of the abducens nerve

Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent episodes of migraine-like headaches associated with extrinsic ocular musculature palsy. In this article, we report a patient with OM that presented recurrent palsy of the abducens nerve and other atypical features. Case reports of OM with abducens nerve palsy were also reviewed.     

Headache Associated With Pituitary Adenomas

The objectives of this study were to analyze the characteristics of headache in patients with pituitary adenoma and to investigate the mechanisms involved.
Fifty-one patients (27 females and 24 males) with pituitary adenoma were examined. Nineteen (37.3%) of these patients (13 females and 6 males) had headache preoperatively. Most commonly, the headache was generalized (42.1%); overall headache was more frequent in the anterior half of the head (84.2%). Seventeen (89.5%) patients had bilateral headache. Headache was usually described as head heaviness (57.9%) and continuous (57.9%). Pulsating headache and dull pain were only reported by the female patients and were mostly intermittent. The mean age of patients with headache was younger than that of those without headache. Headache was more prevalent in patients with a prolactin-secreting adenoma (57.1%). There were no correlations between visual disturbances, hypopituitarism, tumor size, or cavernous sinus invasion and headache. Hemorrhagic pituitary adenoma in 4 (57.1%) of 7 patients did not always contribute to headache. The headache was improved after surgery in 14 (73.6%) of the 19 patients. In the male patients who survived postoperatively (5 of 6), headache was improved.     

15例垂体巨大腺瘤患者调强放射治疗效果分析

目的分析调强放射治疗技术治疗垂体巨大腺瘤的临床实践经验,以期为临床诊疗提供借鉴。方法回顾性分析2012年10月至2018年10月于北京协和医院放射治疗科接受直线加速器6 MV-X线调强放射治疗(56～60 Gy/28～30次,5次/周)的垂体巨大腺瘤患者资料,以肿瘤生长控制率、激素缓解率、放射治疗相关并发症为指标评价患者的治疗效果。结果共15例符合纳入标准的患者入选本研究,其中男性8例,女性7例;中位年龄为32岁。肿瘤生长控制率为93.3%(11例部分缓解,3例肿瘤稳定,1例发展为垂体癌);7例功能性垂体巨大腺瘤患者中,1例激素水平完全缓解,2例部分缓解。4例患者采用调强放射治疗联合替莫唑胺治疗,均达到肿瘤部分缓解(中位缓解时间为5个月),缓解率及缓解时间均优于未使用替莫唑胺者。放射治疗后随访期内,4例患者出现新发垂体功能受损,未出现新发或进一步加重的视力减退及视野受损。结论调强放射治疗是垂体巨大腺瘤患者有效的治疗方法,与替莫唑胺联合应用可加快肿瘤体积缩小、缓解占位效应。     

MRI动态增强扫描在垂体微腺瘤诊断中的价值

目的:观察25例脑垂体微腺瘤患者MRI动态增强扫描在垂体微腺瘤诊断中的价值。方法:25例垂体微腺瘤患者血PRL均>40ng/ml。采用德国Siemens Impact 1.0T超导型磁共振扫描仪,行垂体动态增强扫描时,用对比剂Gd-DTPA(马根维显),其剂量为0.1mmol/kg,采用快速自旋回波序列。结果:常规平扫25例中有15例可见异常信号改变,占60%,而动态增强扫描后22例可见正常垂体腺、漏斗、海绵窦逐一明显强化,微腺瘤则尚未强化仍呈低信号区,形成鲜明对比的图像特征,占88%。平扫垂体一侧饱满或T1、T2未见异常信号者并不干扰此特征的出现。结论:MRI动态增强扫描具有特征性征象,在冠状位上对垂体微腺瘤最具有诊断意义。     

Symptomatic Hypnic Headache Secondary to a Nonfunctioning Pituitary Macroadenoma

We report the case of a woman whose hypnic headache syndrome ceased following pituitary tumor removal. Symptomatic hypnic headache cases are rare, but are starting to appear in the literature. Until more is known, brain neuroimaging, ideally with magnetic resonance imaging, should be considered when the initial diagnosis of hypnic headache is made.     

原发垂体性生长激素缺乏儿童垂体形态学的MRI研究

【目的】研究原发垂体性生长激素缺乏症（GHD）儿童垂体形态学特点。【方法】选择196例2～15岁原发垂体性GHD儿童（研究组）的垂体MRI资料,于SE序列T1WI头颅正中矢状及冠状面上观察垂体大小、形态及信号特征,并与180例同龄同性别健康儿童（对照组）匹配分析比较。【结果】研究组与对照组垂体上缘形态及信号特点差异有显著性,垂体高度和垂体柄宽度研究组低于对照组（P〈0．01）。原发垂体性生长激素缺乏垂体MRI主要表现为垂体发育差,垂体缩小和垂体柄异常改变。【结论】在观察GHD形态学改变时除重点注意垂体高度时还要综合垂体上缘形态、信号特点及垂体柄宽度几个方面,诊断时需紧密结合临床与实验室检查。     

神经导航显微镜下经鼻蝶垂体瘤切除术的疗效观察

目的：探讨神经导航显微镜下经鼻蝶垂体瘤切除术对患者自体功能相关激素水平及视觉功能的影响。方法：垂体瘤患者87例,根据手术时间分为对照组42例、观察组45例。对照组采用神经内镜经鼻蝶垂体瘤切除术,观察组采用神经导航显微镜下经鼻蝶垂体瘤切除术。随访1月,比较2组手术相关指标、垂体功能相关激素水平、视觉功能、并发症等。结果：观察组的手术时间、住院时间短于对照组,出血量大于对照组（P<0.05或P<0.01）;促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、促肾上腺皮质激素（ACTH）、泌乳素（PRL）明显高于对照组,皮质醇（COR）明显低于对照组（均P<0.05）;视野平均缺损（MD）值、视野模式标准差（PSD）低于对照组,视野指数（VFI）高于对照组（P<0.05或P<0.01）;2组脑脊液漏等并发症比较差异无统计学意义（P>0.05）。结论：神经导航显微镜下经鼻蝶垂体瘤切除术有助于促进患者垂体功能相关激素水平恢复,改善视觉功能。     

PTTG和C-myc在垂体腺瘤中的表达及其与肿瘤复发的关系

目的:通过检测PTTG和C-myc在垂体腺瘤中的表达来探讨它们与垂体腺瘤侵袭和复发的关系。方法:采用免疫组化方法检测PTTG和C-myc在侵袭性、非侵袭性及复发性垂体腺瘤中的表达。结果:PTTG在侵袭性和复发性垂体腺瘤中的表达水平显著高于非侵袭性垂体腺瘤,均P<0.05。C-myc的表达在侵袭组和非侵袭组、复发组与侵袭组、复发组与非侵袭组之间均无统计学意义,均P>0.05。结论:PTTG与垂体腺瘤侵袭性和术后复发可能密切相关。而C-myc可能不能作为评价垂体腺瘤侵袭性的指标。     

Migrainelike Headache in a Patient With a Hemorrhagic Pituitary Macroadenoma

A 23-year-old woman presented with a 4-day history of a severe migrainelike headache with a normal neurologica examination. The headache resolved after a ketorolac injection, but recurred a few hours later. An MRI scan of the brain showed a hemorrhagic pituitary macroadenoma for which she underwent transsphenoidal removal of the tumor 1 month later. Although uncommon, pituitary hemorrhage with and without apoplexy should be considered in the differential diagnosis of acute headache. Pituitary hemorrhage can be routinely identified on an MRI scan even without pituitary views. However, the pathology can be overlooked and underimaged on a CT scan for acute headache using 10-mm and even 5-mm slices.     

垂体瘤术后并发症17例分析

目的探讨垂体腺瘤术后并发症发生的原因及其治疗方法。方法采用回顾性分析对术后发生多种并发症的17例垂体腺瘤患者的临床资料进行分析。结果17例患者术后出现4例昏迷、高热(23.5%),7例低钠血症(41.2%),2例高钠血症(11.8%),15例尿崩症(88.2%),1例垂体功能减退(5.9%),12例肺部感染(70.6%),7例泌尿系感染(41.2%),3例消化道出血(17.6%)。治愈13例(76.5%),好转1例(5.9%),死亡3例(17.6%)。结论垂体瘤术后可出现多种并发症,影响患者的生存和预后。提高手术操作技巧,术后严密监测生命体征、加强护理、合理使用抗生素等可减少并发症的发生,促进并发症的恢复。