Subacute Pituitary Apoplexy - Analysis of 17 Cases

亞急性腦下垂腺中風

張志任(Chih-Zen Chang) ； 王致仁(Chih-Zen Wang) ； 黃旭霖(Shiuh-Lin Hwang) ； 洪純隆(Shen-Long Hwong)

《The Kaohsiung Journal of Medical Sciences》 15卷2期 (1999/02) Pp. 75-79

https://doi.org/10.6452/KJMS.199902.0075

摘要

腦下垂腺中風在定義上，是患者表現出突發性的頭痛，視力下降，視線糢糊，甚至於失明。假性硬腦膜炎癥狀如意識喪失、頸部僵直、及發燒。在普通的頭部X光中，偶而可發現變大的土耳其鞍時，便必須加以懷疑患者有腦下垂腺中風。腦部電腦斷層攝影可提供簡便且快速的檢查及確實的診斷；患者可接受適當且及時的醫療諸如手術治療、賀爾蒙製劑補充種種。在巨大的腦下垂腺腄中，常可發現水囊的構造以位於腫瘤中，而水囊的內含物為鐵繡色或暗紅色液體或暗紅色血塊。然而患者在臨床上的症狀則毫無症狀或輕微的頭痛至眼睛糢糊，甚至於失明。在臨床上診斷為亞急性腦下垂腺中風。亞急性腦下垂腺中風的患者在回述其病史時，常常可以發現患者曾經有嚴重頭痛、嘔吐、昏迷、或視力全盲或半盲的情形。但是病情常可回復到正常狀態。在放射診斷學上，普通的頭部X光中，常可發現變大的土耳其鞍。腦部電斷層攝影上，在腦下垂腺的位置，可發現腺瘤、同質或異質的囊狀的構造。所以可提供簡便快速的診斷。腦部核磁共振檢查可提供進一步分辨腦下垂腺囊腫或腦下垂腺中風；兩者的分別為前者在T1為主的影像為低質、在T2為主的影像為高質；相對的後者在T1及T2為主的影像均為高質。在治療上，亞急性腦下垂腺中風常伴隨著巨大腦下垂腺腫瘤，必需以手術為主，加上術前及術後賀爾蒙製劑補充。才能達到較好的效果。

並列摘要

We retrospectively study 17 cases (total cases 197), receiving surgery at Kaohsiung Medical College Hospital, which are proved to be subacute pituitary apoplexy via preoperative computerized tomograms, magnetic resonance imagings, operative findings and pathological proof. Fourteen patients had headache; 15 cases were with visual disturbance including visual defect, blindness. One case was found incidentally to have a cerebral vascular attack. None of these cases received bromocriptine. Preoperative computerized tomograms (CT) aided the initial diagnosis and magnetic resonance imaging (MRI) is preferred for radiological investigation in displaying the metabolic products of hemorrhage within the pituitary tumors. Operative findings revealed xanthochromic fluid with liquid-like tumor debris or chocolate-like content. All these patients received hormone supplement when pituitary apoplexy was highly suspected.

並列關鍵字

subacute pituitary apoplexy ； tumor bleeding