Sandbox:Akshun: Difference between revisions

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* Speech disturbance
* Speech disturbance
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[[Lumbar puncture|Lumbar puncture (LP)]] seems necessary when there is a strong suspicion of subarachnoid hemorrhage. [[Lumbar puncture|Lumbar puncture (LP)]] is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.<sup>[[Subarachnoid hemorrhage laboratory findings#cite note-pmid2556195-1|[1]]][[Subarachnoid hemorrhage laboratory findings#cite note-pmid2191083-2|[2]]]</sup>
[[Lumbar puncture|Lumbar puncture (LP)]] seems necessary when there is a strong suspicion of subarachnoid hemorrhage. [[Lumbar puncture|Lumbar puncture (LP)]] is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.<sup>[[Subarachnoid hemorrhage laboratory findings#cite note-pmid2556195-1|[1]]][[Subarachnoid hemorrhage laboratory findings#cite note-pmid2191083-2|[2]]]</sup>


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* Focal symptoms of brain damage
* Focal symptoms of brain damage
* Associated co-morbid conditions like tuberculosis, etc
* Associated co-morbid conditions like tuberculosis, etc
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|'''CT and MRI'''
* These tests are of higher value to detect intracranial lesions.
* They have higher sensitivity and specificity compared to X-rays.
'''Biopsy'''
* Biopsy of the lesion is needed to know the nature of the lesion.
'''X ray'''
* X- ray skull is quite a non specific test, but useful if any of the lesions are calcified.
 
* X- ray chest may be warranted if any metastatic tumor is suspected.
'''Blood tests'''
* Serum BNP (Brain natriuretic peptide)
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|[[Infarction]]
|Cerebral Infarction ([[Stroke]])
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|The symptoms of an ischemic stroke vary widely depending on the site and blood supply of the area involved. For more information on symptoms of ischemic stroke
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Revision as of 16:49, 20 July 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Pituitary apoplexy must be differentiated from other diseases that cause severe headache such as subarachnoid hemorrhage, meningitis, cerebral hemorrhage, intracranial mass, infarction, intracranial venous thrombosis, migraine, cavernous sinus thrombosis, cerebellar hemorrhage and midbrain infarction.

Differentiating Pituitary apoplexy From Other Diseases

Pituitary apoplexy should be differentiated from other diseases causing severe headache for example:

Disease Symptoms Findings
Subarachnoid hemorrhage

Lumbar puncture (LP) seems necessary when there is a strong suspicion of subarachnoid hemorrhage. Lumbar puncture (LP) is the most sensitive techniques to detect the blood in CSF especially 12 hours after onset of symptoms.[1][2]

The classic findings of subarachnoid hemorrhage may include:[3][4][5][6][7]

Meningitis Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. For more information on CSF analysis in meningitis please click here.
Intracranial Mass
  • Headache
  • Nausea
  • Vomiting
  • Change in mental status
  • Seizures
  • Focal symptoms of brain damage
  • Associated co-morbid conditions like tuberculosis, etc
CT and MRI
  • These tests are of higher value to detect intracranial lesions.
  • They have higher sensitivity and specificity compared to X-rays.

Biopsy

  • Biopsy of the lesion is needed to know the nature of the lesion.

X ray

  • X- ray skull is quite a non specific test, but useful if any of the lesions are calcified.
  • X- ray chest may be warranted if any metastatic tumor is suspected.

Blood tests

  • Serum BNP (Brain natriuretic peptide)
Cerebral hemorrhage
  • Increased intracranial pressure (ICP) (headache, vomiting, and depressed level of consciousness) 
  • progression of focal neurological deficits over periods of hours
Cerebral Infarction (Stroke) The symptoms of an ischemic stroke vary widely depending on the site and blood supply of the area involved. For more information on symptoms of ischemic stroke
Intracranial venous thrombosis
Severe headache with decreased visual acuity, ocular palsies, or visual field changes
Complicated migraine
Midbrain infarction
Cavernous sinus thrombosis
Cerebellar hemorrhage
Signs of hypopituitarism (hypogonadism, hypoadrenalism, or hypothyroidism)
Head injury
Lymphocytic hypophysitis
Iatrogenic surgical
Radiation injury
Infections (particularly tuberculosis and mycotic infections)