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...
CANADIAN JOURNAL OF ANAESTHESIA patients required medical attention for their headache. Backache was reported more frequently following SAB (14 patients) than general anaesthesia (five patients). Nausea or vomiting was twice as common after general anaesthesia as SAB and was more frequent following discharge (18 cases) than in the recovery room (seven cases). The mean duration of anaesthesia was longer for the group receiving SAB, 52-12 minutes, compared to 45 ___ 15 min for the group receiving general anaesthesia. The time spent in the recovery room was the same for both groups. The incidence of PDPH in this study is similar to that reported by Neal et al. 3 and does not support the earlier contentions that SAB is unsuitable for outpatients. In carefully selected patients TURP is a suitable procedure for daycare units and either general anaesthesia or SAB is acceptable for this surgery.
We propose that muscle biopsy for diagnosis of MH susceptibility should combine the CHCT with the CICR rate test, which may identify the defective site of Ca release channels.
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