Stimulation of sympathetic vasomotor centers by lesions in the posterior fossa has been described in humans and animals. We describe a patient with a pheochromocytoma-like syndrome and a basilar artery aneurysm. Repair of the aneurysm was followed by disappearance of hypertensive episodes. Posterior fossa lesions must be considered in patients with hypertensive crises when diagnostic procedures do not indicate an adrenal or extra-adrenal pheochromocytoma.
The first consideration in evaluating the thyroid nodule is whether it is functioning and causing hyperthyroidism. Autonomous nodules should be treated with either surgery or I-31, with surgery favored due to the possibility, although small, of malignancy. Thyroid scans are no longer recommended during the initial evaluation of the thyroid nodule. Ultrasound is useful in determining the size of the nodule and whether it is multinodular thyroid disease, but it cannot detect thyroid cancer. Fine needle aspiration biopsy is currently the procedure of choice for evaluating all thyroid nodules. For accuracy of the cytological analysis, it is important that adequate tissue samples be obtained. False negative findings are of most concern to the clinician and occur in 2-10% of reported fine needle aspiration biopsy series. Nodules thought to be benign will need continued follow-up.
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