Although beneficial in allergic and parasitic disease, eosinophils exert nonspecific toxic effects upon host tissues, especially the central and peripheral nervous systems. Eosinophil-induced neurotoxicity is characterized by axonal neuropathy, cerebral infarction, and dementia. Eosinophil-derived cytotoxic proteins are fundamental to the pathogenesis of this disorder.
We studied a man with cerebrospinal fluid rhinorrhea due to bromocriptine-induced shrinkage of a prolactin-secreting pituitary tumor. Unlike other reported cases with pituitary tumors and rhinorrhea, our patient never had previous radiotherapy or surgery. The fistula was clearly demonstrated by CT. The original signs included homonymous hemianopia due to a left optic tract compression. Bromocriptine treatment is an invaluable adjunct in long-term management of invasive prolactinomas, but surgical intervention is indicated if a CSF fistula results.
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