Recurrence of hypertensive intracerebral hemorrhage confirmed by computed tomography scan has rarely been reported. The authors have experienced nine cases of recurrent hemorrhage among 494 cases of hypertensive intracerebral hemorrhage. Recurrence rate was 1.8%. There were eight males and one female with an average age of 60.5 years. Six cases had their first and second attacks in ganglionic regions. Among them, three cases had the second attack in the ipsilateral side, and the other three cases had the second attack in the contralateral side. Two cases had the first attack in the thalamic and the second in the cerebellar regions. One case had the first attack in the pontine and the second in the putaminal regions. Intervals between the first and second attacks were within 6 months for ipsilateral ganglionic attacks and over 4 years for contralateral ganglionic attacks. In all cases systemic blood pressure was normalized or well controlled by antihypertensive agents after the first attack. The mechanism of rebleeding has not been clarified.
SummaryA case of pituitary apoplexy, which presented with hyperaesthesia in the distribution of the ophthalmic division of the left trigeminul nerve and a left sixth nerve palsy following cholecystectomy, is reported. Computed tomography and magnetic resonance imaging revealed a large intrasellar mass which extended laterally into the left cavernous sinus and showed evidence o# old and recent haemorrhage within the tumour. This case demonstrates that patients who present with unusual neurological symptoms involving the cranial nerves after general anaesthesia, should undergo neurological and radiological investigations. Key wordsBrain; pituitary apoplexy. Surgery: cholecystectom y . Complications; neurological.Pituitary apoplexy is a rare clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to infarction or haemorrhage. It is characterised by the sudden onset of headache, ocular palsies, visual disturbances, and an altered state of consciousness and is lifethreatening if untreated. Although the exact pathophysiology of its development is not known, some predisposing factors such as sudden trauma, anticoagulation, alteration of cerebrovascular pressure gradients, diabetic ketoacidosis. oestrogen or bromocriptine therapy, angiography, and radiotherapy have been suggested [ 1-31. Although pituitary apoplexy has been reported following coronary artery bypass surgery [4], there have been no convincing reports of its occurrence after noncardiac surgery.We report a case of pituitary apoplexy which presented with a left sixth nerve palsy and supra-orbital neuralgia after cholecystectomy, which was performed under a combination of general anaesthesia and epidural analgesia. Case historyA 47-year-old man was admitted for a cholecystectomy for asymptomatic cholelithiasis, which was discovered at a clinical survey. His past medical history was unremarkable except for a 2-year history of oedema of the legs of unknown origin. Physical examination and laboratory investigations, including endocrinological examination, showed no other abnormalities.An epidural catheter was inserted without difficulty. After uneventful induction of general anaesthesia with thiopentone 300 mg and midazolam 10 mg, anaesthesia was maintained with 67% nitrous oxide in oxygen, and I YO carbocaine 15 ml was given through the epidural catheter. Three further injections of 1% carbocaine 5 ml were given over the 3 h period of surgery. Cardiovascular and respiratory parameters remained normal apart from a decrease in systolic blood pressure of about 30% of the pre-induction value following the third epidural injection, which was treatment with methoxamine 3 mg. Surgery and anaesthesia were otherwise uneventful. The patient's only complaint in the recovery period was that of pain on the left side of his forehead. The next day he complained of double vision in addition, and neurological examination revealed hyperaesthesia affecting the ophthalmic division of the left trigeminal nerve and a left sixth nerve palsy. A local anaest...
A 15-year-old boy was referred to our hospital with a rare case of inflammatory pseudotumor (IP) in the lateral ventricle manifesting as complaints of headache and low-grade fever. Computed tomography and magnetic resonance imaging demonstrated a well-demarcated and enhanced tumorous lesion in the right lateral ventricle. Intraoperative findings showed a hard mass with feeding arteries from the choroid plexus around the foramen of Monro in the right lateral ventricle, although the mass was not attached to the wall of the lateral ventricle. The lesion was totally resected, and the histopathological diagnosis was IP. The present and previous cases suggest that good outcomes are obtained by surgical removal and treatment of hydrocephalus. IP should be considered in the differential diagnosis of hard tumorous lesions with good enhancement and no tumorous staining in the ventricle.
Wilms tumor (WT) is the most common malignant kidney tumor in children. High blood pressure is seen in up to 55% of children with WT. However, hypertensive cardiomyopathy with congestive heart failure due to WT is remarkably rare, with only several cases reported worldwide. In this report, a pediatric case of WT with hypertension causing hypertensive cardiomyopathy and congestive heart failure is presented. An 8-month-old male child with abdominal distension was seen by his primary physician. He was referred to our hospital for further examination and treatment. Abdominal contrast-enhanced computed tomography demonstrated a weakly enhancing, large abdominal mass, which was larger than 12 cm. Two-dimensional transthoracic echocardiography showed a diffuse hypokinetic left ventricle. The patient was diagnosed with cardiomyopathy caused by hypertension. Open surgical resection of the mass was successfully performed. His postoperative course was uncomplicated, and the patient was successfully discharged. The plasma renin activity was maintained at a high level even after left nephrectomy, suggesting that the right kidney was likely the source of renin secretion. Mechanical compression of the right renal blood vessels by a greatly enlarged left kidney can cause right renal ischemia, which activates renin excretion. Nephrectomy can be an effective treatment for a WT patient with hypertension causing hypertensive cardiomyopathy, and then cardiac function will be improved within several weeks. We recommend routine echocardiography surveillance in patients with WT. This report can help pediatric surgeons become more familiar with cardiomyopathy caused by WT.
A 33-year-old man was admitted to our hospital to undergo an evaluation to determine the cause of secondary hypertension. Computerized tomography angiography (CTA) showed bilateral multiple renal arteries with significant stenosis of the right extra-renal artery due to fibromuscular dysplasia and segmental impairment of renal perfusion. Although the plasma aldosterone concentration and plasma renin activity were within the normal ranges, percutaneous balloon dilatation of the stenotic lesion resolved his hypertension, leading to a diagnosis of renovascular hypertension caused by segmental renal ischemia due to extra-renal artery stenosis. CTA should be considered during the examination of patients with early-age hypertension, even if the plasma renin activity is not sufficiently elevated.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.