Pituitary Abscess Showing High Uptake of Thallium-201 on Single Photon Emission Computed Tomography. Case Report.

Shimamura, Norihito; Ogane, Kazumi; Takahashi, Toshio; Tabata, Hidefumi; Ohkuma, Hiroki; Suzuki, Shigeharu

doi:10.2176/nmc.43.100

Cited by 12 publications

(7 citation statements)

References 30 publications

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“…The second point is the "perfusion" pattern observed in the ictal SPECT. Similar PET or SPECT findings with different radiotracers have been observed in pharyngeal and pituitary neuroendocrine tumors or abscess (4,5) . Our clinical and laboratory investigations excluded the presence of mass lesions.…”

Section: Discussionsupporting

confidence: 67%

Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base

Wichert‐Ana

Ferruzzi

Alexandre

et al. 2006

J. epilepsy clin. neurophysiol.

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INTRODUCTION: Generalized tonic-clonic seizures (GTCS) are among the most dramatic types of epileptic seizures and may be accompanied by rising blood pressure and pulse rate, physical injuries from falling, muscular convulsions, tongue biting, or aspiration pneumonia. Epistaxis is an uncommon complication of generalized seizures and investigations should exclude local or systemic disorders. OBJECTIVE: We aim to report a 29-year-old male patient with medically intractable right temporal lobe epilepsy whose ictal SPECT showed a conspicuous high extracerebral accumulation of the tracer at the skull base. METHODS: The tracer 99mTc-ECD was injected during a GTCS complicated by simultaneous epistaxis during a long term video-electroencephalographic monitoring. RESULTS: Initially, SPECT images showed an unexpected hot spot at the skull base suggesting pharyngeal or pituitary tumors. Clinical history disclosed chronic sinusitis and rare episodes of epistaxis. White and red cells blood count, platelet count, serum biochemistry, coagulation tests, and rest arterial blood pressure were normal. Computed tomography and MRI excluded sinusoidal expansive or vascular lesions, head trauma, fractures or acute infections. Subtracted SPECT disclosed a focal high concentration of the radiotracer within the left sphenoid sinus, probably related to the nose bleeding. CONCLUSION: This is a singular case of a brain SPECT artifact secondary to a nasal bleeding during a generalized seizure that was misinterpreted as neoplastic disease. Also, this case raises concerns about the pathophysiological relationship among epileptic seizures, nasal bleedings and chronic sinusitis.

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Section: Discussionsupporting

confidence: 67%

Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base

Wichert‐Ana

Ferruzzi

Alexandre

et al. 2006

J. epilepsy clin. neurophysiol.

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“…Shimamura et al suggests that a way of differentiating both pituitary lesions is by the high uptake of the abscess on thallium-210 single-photon emission CT on the early and delayed images. 13 …”

Section: Discussionmentioning

confidence: 99%

Pituitary abscess

Mohammed¹,

Agha

Helmy

2017

BMJ Case Reports

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Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.

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“…Vates et al reported 24 cases drawn from a series of more than 3500 patients who underwent pituitary surgery [2]. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], and a summary of these cases, which we selected for analysis, has been tabulated in Table 2, 3 and 4.…”

Section: Discussionmentioning

confidence: 99%

Pituitary abscess: our experience with a case and a review of the literature

Dalan

Leow

2007

Pituitary

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Pituitary abscess is a rare disease. Due to its potentially high mortality and morbidity rate, it should be considered in the differential diagnosis of sellar masses. Despite recent advances in radiological investigations, making a definitive diagnosis preoperatively remains challenging. This 45-year-old Indian gentleman presented with severe throbbing headache for six months. Magnetic resonance imaging of the brain revealed a sellar mass with peripheral enhancement that was misdiagnosed as a pituitary macroadenoma. A trans-sphenoidal excision was done, which surprisingly yielded only pus that was drained accordingly from the lesion. Fungal and bacterial cultures were negative. However this patient subsequently lost complete function of the pituitary gland, resulting in central diabetes insipidus and required permanent hormonal replacement therapy in the deficient endocrine axes. A Medline search was conducted and a review of 24 cases reported in the last 5 years discussed.

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Pituitary Abscess Showing High Uptake of Thallium-201 on Single Photon Emission Computed Tomography. Case Report.

Cited by 12 publications

References 30 publications

Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base

Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base

Pituitary abscess

Pituitary abscess: our experience with a case and a review of the literature

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