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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 45-year-old female presented with blurred vision, headache, and abnormal thirstiness. She was not pregnant nor postpartum. She had diabetes insipidus and bitemporal hemianopsia. Radiological evidence suggested a mass arising in the sella turcica with extension into the parasellar and suprasellar regions. Carotid angiography showed occlusions of bilateral internal carotid arteries at the cavernous portions. The mass was subtotally removed by the trans-sphenoidal approach and was histologically diagnosed as an adenohypophysitis. Laboratory data showed the patient to be in an active state of autoimmune disorder and hypopituitarism. When a patient presents with pituitary insufficiency and an enhanced intrasellar mass lesion on computed tomographic scan, lymphocytic adenohypophysitis must be included in the differential diagnosis.
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PMID:Lymphocytic adenohypophysitis accompanying occlusion of bilateral internal carotid arteries--case report. 169 52

Visual field defect due to pituitary adenoma ordinarily shows bitemporal hemianopsia. But we experienced a case presenting binasal inferior quadrants hemianopsia. A 60-year-old woman was admitted to our hospital complaining of headache and blurred vision. At ophthalmologic examination, the visual acuity on the right was 0.02 and on the left 0.3. Visual field showed a loss of bilateral inferior nasal quadrants. There was neither pallor nor edema of either of the optic disks. A computerized tomography (CT) scan showed an enhancing mass in the intra- and suprasellar region. But despite remarkable suprasellar expansion of the tumor, the straight view of bilateral carotid angiograms revealed no elevation of the first part of the anterior cerebral arteries (ACA). On the lateral view, the terminal portion of the precommunicating part of the left ACA showed rather marked anteroinferior displacement. 2 mm thin sliced CT scans at the suprasellar region revealed that the left internal carotid artery had been touching the lateral portion of the tumor and the ACA had been displaced anteriorly by the tumor. Two weeks after admission, transsphenoidal tumor resection was carried out. Total removal was achieved and histological examination showed that the tumor was nonfunctioning chromophobe adenoma. The postoperative course was uneventful except for transient diabetes insipidus. The patient's visual acuity rapidly improved to 0.8 on the right and 0.5 on the left two weeks after operation. Although there was still a tendency for left inferior nasal field defect, remarkable improvement was obtained subjectively and objectively. According to the findings of CT scans and cerebral angiograms, binasal hemianopsia may have been produced by the mechanism as follows.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of pituitary adenoma presenting binasal inferior quadrants hemianopsia]. 261 6

The use of trans-sphenoidal pituitary alcohol injection was assessed in a district general hospital for the treatment of diffuse bilateral cancer pain in 26 patients. Fourteen patients received a total of 43 injections. Hormonal and non-hormonal dependent cancers were treated, with complete pain relief in ten patients and partial relief in a further seven patients. The duration of relief was variable, and usually less than 6 weeks, although two patients had complete pain relief for 5 and 7 months respectively. No cases of meningitis or cerebrospinal fluid rhinorrhoea occurred. Nasal antiseptics and vasoconstrictors were not used. Temporary pupil dilatation occurred in eight patients, of whom one had prolonged blurred vision for small print. Transient diabetes insipidus was common (53%), although only five patients needed permanent treatment. Death from their disease occurred in 65% of patients within 3 months. Survival was shorter than in series from specialist centres, suggesting later referral for pain relief. The technique is an inexpensive and valid form of treatment for cancer pain in a district hospital, but should not be undertaken lightly in view of the possible complications.
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PMID:Pituitary alcohol injection for cancer pain. Use in a district general hospital. 620 49

We report a case of a pituitary mass associated with sarcoidosis. Natural regression of the mass was demonstrated after the replacement of corticosteroid hormone. A seventy-one-year old man presented with blurred vision and general fatigability, and admitted to our hospital. He was diagnosed to have ophthalmic and pulmonary sarcoidosis. Two months later, he consulted our hospital again, with complaints of fatigability and vomiting. Laboratory data showed hyponatremia, and CT scan revealed a suprasellar mass. He had no neurological deficits. Diabetes insipidus was not observed. Magnetic resonance image showed a heterogeneously enhanced intrasellar and suprasellar dumbbell shaped mass and thickening of the pituitary stalk. Hormonal examination revealed corticosteroid insufficiency and hypothyroidism, possibly caused by the pituitary mass. Replacement of corticosteroid hormone significantly improved his fatigability. Two months later, follow-up MRI showed regression of the pituitary mass. Based on the clinical and radiological findings, pituitary mass was strongly suggested to be caused by sarcoidosis. We recommend prompt steroid treatment for such a pituitary mass and strict follow-up MRI study.
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PMID:[A case of a pituitary mass in association with sarcoidosis]. 1076 47

The rate of symptomatic improvement of visual symptoms associated with hematogenous metastases to the sella and pituitary was evaluated retrospectively in seven patients (five men, two women; mean age, 52.3 years) with primarily visual symptoms (diplopia alone in three, diplopia with blurred vision in one, blurred vision alone in one, loss of peripheral vision in one, and unilateral complete blindness in one). Symptom duration ranged from 0.5 to 2 months. The primary diseases were non-small cell lung cancer in two patients, renal cell carcinoma in two patients, prostate cancer in two patients, and medullary thyroid carcinoma in one patient. All patients had widespread metastatic disease. Three patients had a suprasellar tumoral component. One patient had a clival extension, and one patient had extension into the cavernous sinus. All underwent trans-sphenoidal surgery to correct visual symptoms. Gross total resection was achieved in three patients. Subtotal resections and a partial resection were performed in three patients and one patient, respectively. Surgical blood loss averaged 282 mL. One patient died from sepsis. Five patients developed complications (cerebrospinal fluid leakage in three, diabetes insipidus in two, anterior pituitary dysfunction in two, and colitis in one). At a mean follow-up of 15 months, three patients were alive. Visual symptoms improved in five patients and were unchanged in two. Trans-sphenoidal surgery helped improve visual symptoms in most patients. The morbidity rate was high and likely related to the locally destructive and extensive nature of the lesions in overall morbid patients with widespread metastatic disease. Unless nonoperative measures can provide equal results, however, this approach provides reasonable palliation.
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PMID:Efficacy of Trans-septal Trans-sphenoidal Surgery in Correcting Visual Symptoms Caused by Hematogenous Metastases to the Sella and Pituitary Gland. 1876 52

A 23 year-old patient was referred to the endocrine outpatient clinic with the suspicion of diabetes insipidus as he complained of nycturia and polydipsia since 2-3 months. Further he presented with nausea, vomiting, loss of appetite, rapid weight loss, diffuse body pain and fatigue. No headache, blurred vision, or fever were reported. The clinical examination showed sexual infantilism (poor beard, pubic and axillary hair growth, small testis). The patient's skin was strikingly pale as well as dry and scaly. Lymph node palpation was unremarkable. Endocrine evaluation revealed diabetes insipidus as well as complete anterior pituitary insufficiency. MR imaging demonstrated contrast-enhancing mass lesions at the pineal gland, hypothalamus, and anterior horn of lateral ventricles bilaterally. The localization pattern deemed to be highly suspicious for intracranial germinoma. As beta-HCG and AFP were negative in serum and cerebrospinal fluid the diagnosis of germinoma was confirmed histologically. After radiotherapy with cranio-spinal radiation therapy with 24 Gy followed by two weeks of local tumor boost with 16 Gy, the posttherapy MRI scan indicated complete tumor removal. This case demonstrates a very rare and potentially curable tumor as the cause of panhypopituitarism in adults.
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PMID:Intracranial germinoma as a very rare cause of panhypopituitarism in a 23-year old man. 1905 25

Sarcoidosis is a chronic disease of unknown aetiology. Neurosarcoidosis is registered in 5% of patients with sarcoidosis. Clinical manifestations of sarcoidosis are numerous and diverse. Manifestation of Neurosarcoidosis includes partial- and grand-mal seizures, low-grade fever, headache, increased intracranial pressure, visual disturbances, diabetes insipidus, amenorrhea- galacterorrhea syndrome and pituitary failure, hypogonadotropic hypogonadism, hyperprolactinemia, unilateral and bilateral facial palsy, infiltration of meninges (aseptic meningitis) and nerve roots, leptominingitis, pachymeningitis with cranial neuropathies, pseudotumor, mild cognitive disorder, psychosis, delirium, dementia, disorientation, amnesia, progressive visual deterioration and proptosis, axonal polyneuropathies, mononeuropathies, chronic polyradiculoneuritis, peripheral neuropathy, cranial nerve abnormalities, radiculopathies, peripheral neuropathy, mononeuritis multiplex, progressive numbness and deep sensation disturbance in bilateral lower extremities, hemiplegia, hyperreflexia with pathological reflexes and hypesthesia, upward gaze palsy, spinal cord compression, dysarthria, dysphagia, weakness, episodes of blurred vision, diplopia, intracerebral hemorrhage, neuro-ophthalmic manifestations, intranuclear ophthalmoplegia, dysorientation, vasculitis presenting with strokes, intracranial hypothalamic lesion, paresthesis, hemiparesis, myelopathy in the cervico-thoracic region, lumbar pain, sensory level and inability of lateral gaze (Tab. 2, Ref. 60).
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PMID:Clinical manifestations of neurosarcoidosis. 1982 43

Xanthoma disseminatum (XD) is a rare, benign, non-Langerhans cell histiocytic disorder. The pathogenesis is not clear. It manifests with multiple, grouped, red-brown to yellow papules and nodules involving the skin, mucous membranes, and internal organs. We present a case of progressive XD in a 10-year-old male child. The patient presented with progressive, bilateral and symmetrical, reddish-brown, coalescent papules on the neck, around both eyes and all over his trunk and extremities. Skin lesions were accompanied by blurred vision and hoarseness of voice. Examination revealed xanthomatous infiltration of cornea, oral, pharyngeal, and laryngeal mucosae. The patient had diabetes insipidus that was diagnosed 2 years before the appearance of skin lesions. Medical treatment with corticosteroids (20 mg/day) and azathioprine (2 mg/kg/day) did not stop the disease progression.
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PMID:Xanthoma disseminatum: a progressive case with multisystem involvement. 2462 43

Sarcoidosis is a well-recognized systemic granulomatous process which involves the central nervous system in 5-15% of patients. One of the more frequent sites of central nervous system involvement is the pituitary and hypothalamic region. Involvement of the sellar region by sarcoidosis is overall an infrequent occurrence, comprising less than 1% of all intrasellar lesions. Patients typically present with an infiltrative lesion on imaging studies and clinically with symptoms related to diabetes insipidus or hyperprolactinemia. This report describes a 38-year-old woman who initially presented with a variety of symptoms including headaches, light sensitivity, nausea and vomiting, acute visual changes, cold intolerance, amenorrhea, decreased libido, fatigue and galactorrhea. She had an elevated serum prolactin level and evidence of oligoclonal bands in the cerebrospinal fluid. Imaging studies discovered a 1.8cm mass involving the pituitary gland and compressing the optic chiasm. The lesion was excised and microscopically was marked by a chronic inflammatory cell infiltrate and scattered nonnecrotizing granulomas. Stains and microbiologic cultures failed to demonstrate microorganisms. There was no evidence of other organ involvement on postoperative imaging. She was treated with prednisone with improvement of symptoms and subsequently required methotrexate to treat left eye pain and blurred vision, 29months after her surgery. Achieving treatment control in patients with pituitary and hypothalamic improvement in sarcoidosis still remains a challenge.
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PMID:Biopsy proven pituitary sarcoidosis presenting as a possible adenoma. 2745 30

Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient's pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.
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PMID:Suprasellar Epidermoid Cyst Originating from the Infundibulum: Case Report and Literature Review. 3051 Aug 61


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