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Case Reports 2011; 32(3): 238-241 PubMed PMID: 21712786 Citation  Keywords:  Atrophy, Brain:diagnostic imaging, Fatal Outcome, Female, Humans, Hydrocortisone:blood, Hypokalemia:etiology, Magnetic Resonance Imaging, Middle Aged, Pituitary ACTH Hypersecretion:pathology, Tomography, X-Ray Computed,.   

: We present a 56-year-old patient with cyclic Cushing's disease (CCD) observed for 28 months, who presented clinically and biochemically with alternating episodes of hyper-, normo- and hypocortisolemia. The course of the disease was fatal, the patient died due to severe hypokalemia....

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Evaluation Studies 2010; 31(6): 796-800 PubMed PMID: 21206436 Citation  Keywords:  Acromegaly:diagnostic imaging, Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Paranasal Sinuses:diagnostic imaging, Temporal Bone:diagnostic imaging, Tomography, X-Ray Computed,.   

OBJECTIVE: Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly.

CONCLUSIONS: 1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly....

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Journal Article 2010; 31(6): 814-817 PubMed PMID: 21196928 Citation  Keywords:  Adult, Diagnosis, Differential, Electroencephalography, Epilepsy:diagnosis, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Seizures:diagnosis, Tomography, X-Ray Computed,.   

OBJECTIVE: Authors warn of difficulties in diagnostic of solitary epileptic seizure and epilepsy.

MATERIAL AND METHODS: Our groups have been made up of patients, who have been dismissed from our clinic in the period from January 1997 to January 2007 with diagnosis of solitary unprovoked epileptic seizure (n=84) and epilepsy with sporadic epileptic seizure (n=179). We have evaluated the clinical typology of epileptic seizure, EEG findings and results of imaging methods and we determined the part of patients with complete diagnostic concordance between clinical image of epileptic seizure and results of auxiliary diagnostic methods.

RESULTS: We have denoted the complete diagnostic concordance among the clinical image, EEG findings and results of imaging methods only in 13.1% of patients after solitary unprovoked epileptic seizure and in 24.02% of patients with diagnosis of epilepsy with sporadic epileptic seizures. The receiving diagnosis of unclear seizure status was determined at 49.14% of patients dismissed with diagnosis of solitary epileptic seizure and at 40.78% of patients dismissed with diagnosis of epilepsy with sporadic epileptic seizures in 10 year time period.

CONCLUSION: Our results repeat the confirmation that the diagnostic of seizure disorders, with and without disturbance of consciousness, belong to the difficult part in the clinical praxis....

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Comment 2010; 31(6): 728; author reply 729-730 PubMed PMID: 21196919 Citation  Keywords:  Brain:pathology, Child, Diagnosis, Differential, Diffusion Magnetic Resonance Imaging, Edema:diagnosis, Humans, Magnetic Resonance Imaging, Male, Nephrotic Syndrome:complications, Posterior Leukoencephalopathy Syndrome:diagnosis,.   

: Kabicek and colleagues described a case of nephritic-syndrome-associated posterior reversible encephalopathy syndrome (PRES) (Kabicek, et al. 2010). This adds to the accumulating evidence that PRES can be associated with disorders other than hypertension. However, we wonder how the authors would explain the neuroimaging findings unsuggestive of vasogenic oedema. PRES (also named reversible posterior leukoencephalopathy syndrome, RPLS) represents a clinicoradiological syndrome characterized by vasogenic oedema as revealed by apparent diffusion coefficient (ADC) map of diffusion-weighted imaging (DWI) (Bartynski, 2008). The pathogenesis of PRES has been suggested to be autoregulation failure and endothelial dysfunction (Sharma, et al.). ......

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Case Reports 2010; 31(5): 597-601 PubMed PMID: 21173743 Citation  Keywords:  Adult, Anti-Bacterial Agents:therapeutic use, Biopsy, Brain Abscess:drug therapy, Diagnosis, Differential, Female, Headache:etiology, Humans, Magnetic Resonance Imaging, Neurosurgical Procedures, Pituitary Diseases:complications, Sphenoid Bone:surgery, Tr.   

OBJECTIVES: Pituitary abscess is rare disease and the correct diagnosis is difficult because there are non-specific symptoms and it is often radiologically indistinguishable from other pituitary lesions.

CASE PRESENTATION: We present one case of pituitary abscess that constitute 0.15% of all pituitary adenomas operated in our department in the 20 years. A 49-year-old woman presented with a history of 10 months bifrontal headache. The MRI showed cystic intra and suprasellar mass with ring enhancement after contrast injection. During transsphenoidal surgery, copious yellowish pus was found. Antibiotic therapy was performed. Histological study of the cyst wall confirmed the diagnosis of pituitary abscess.

CONCLUSION: Pituitary abscess should be considered in the differential diagnosis of all other cyst mass in patients with diabetes insipidus....

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Case Reports 2010; 31(3): 297-300 PubMed PMID: 20588234 Citation  Keywords:  Antihypertensive Agents:therapeutic use, Child, Female, Humans, Magnetic Resonance Imaging, Nephrotic Syndrome:complications, Posterior Leukoencephalopathy Syndrome:complications,.   

OBJECTIVE: Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of nephrotic syndrome in children. This clinical condition is caused by localized brain angioedema mostly in parieto-occipital region and results in dramatic and acute features as sudden loss of consciousness, epileptic paroxysms, strong headache or visual disturbances. Uncontrolled hypertension often participates in PRES development.

CASE: We present the case of a 5-year-old girl treated for relapse of nephrotic syndrome.

RESULTS: At the time of edema regression and weight reduction, a sudden loss of consciousness and worsening of hypertension occurred. Brain MRI demonstrated extended multifocal changes strongly suspicious of encephalitis. After exclusion of herpetic encephalitis, the clinical picture was classified as PRES. Successful antihypertensive treatment led to general improvement of the girl's health within 48 hours and resolution of MRI brain hyperintensities occurred within the next three months.

CONCLUSIONS: The aim of our case report is to us remind of possible development of PRES at the time of edema regression in nephrotic syndrome....

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Journal Article 2010; 31(2): 270-274 PubMed PMID: 20424586 Citation  Keywords:  Adult, Blood Glucose:metabolism, Diabetes Complications:blood, Fasting:blood, Female, Hemoglobin A, Glycosylated:metabolism, Humans, Hyperprolactinemia:blood, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Gland:pathology, Prevalence, Prolactin:.   

OBJECTIVE: Prolactin levels have been shown to be reduced in poorly controlled diabetes mellitus; however, diabetic patients with high prolactin levels may be seen in clinical practice. The aim of this study was to evaluate diabetic patients with hyperprolactinemia, and to determine the role of macroprolactinaemia in these patients.

MATERIALS AND METHODS: The study included 174 patients (153 women and 21 men) with hyperprolactinemia, retrospectively reviewed over a 2 years period. Data on presenting symptoms, the presence of diabetes mellitus, prolactin levels, macroprolactin levels, pituitary magnetic resonance imaging were collected in all patients. In addition; HbA1c, fasting blood glucose levels and postprandial glucose levels were collected in diabetic patients.

RESULTS: Of the 174 patients, 27 were diagnosed with diabetes mellitus (15.5%). Eighteen of the diabetic patients with hyperprolactinaemia had macroprolactinaemia (66.6%). The prevalence of macroprolactinaemia in diabetic patients is higher than the non-diabetic population (66.6% vs. 39.5%, p=0.009). In diabetic patients with macroprolactinaemia, HbA1c levels were higher than the diabetic patients without macroprolactinaemia.

CONCLUSION: The prevalence of macroprolactinaemia in diabetic patients was higher than the non-diabetic population. It seems necessary to determine macroprolactin levels in diabetic patients with hyperprolactinaemia; and in this case, further diagnostic evaluation is not warranted....

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Case Reports 2010; 31(2): 174-177 PubMed PMID: 20424585 Citation  Keywords:  Adult, Brain:pathology, Brain Neoplasms:diagnostic imaging, Female, Fetal Diseases:diagnostic imaging, Gestational Age, Humans, Hydrocephalus:diagnostic imaging, Magnetic Resonance Imaging, Pregnancy, Prognosis, Teratoma:diagnostic imaging, Ultrasonograph.   

: Fetal intracranial teratomas are rare neoplasms that can be readily detected via USG and MRI. While early discovery of such a condition may be helpful, the prognosis remains poor. We present a case of a massive intracranial teratoma and hydrocephalus initially detected via USG at 33 weeks of gestation....

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