• Journal of Korean Neurosurgical Society
• /
• 제38권6호
• /
• pp.450-455
• /
• 2005

Objective : Pituitary apoplexy is a rare clinical syndrome caused by pituitary hemorrhage, hemorrhagic infarction, or ischemic infarction within a pituitary tumor or surrounding structure. We analyzed surgical outcomes of pituitary apoplexy. Methods : From 1995 to 2004, we reviewed our experience of 29 cases with pituitary apoplexy. In all patients, pre- and postoperative clinical presentation were checked and endocrine study were performed. Results : The most frequent symptoms were visual disturbance [24 cases, 82.8%] and headache [22 cases, 75.9%]. After surgery, headache improved in 86.4%, 88.9% among 18cases who had preoperative reduction in visual acuity and 75.0% among 12 cases who had preoperative reduction in visual field improved. In endocrine study, long-term steroid and thyroid hormone replacement therapy was necessary in 42.9% of 14 cases presenting preoperative hypopituitarism. Postoperative transient hypopituitarism developed in 5 cases [33.3%] and they all recovered in follow up study. Postoperative endocrinological recovery were in 77.9% of 9 cases with preoperative prolactinoma, 1 case in 2 cases with acromegaly and one case with Cushing disease. Postoperative complications were diabetes inspidus[DI] in 1 case [3.4%]. cerebrospinal fluid[CSF] leakage in 2 cases [6.8%] and death in 1 case [3.4%] due to sepsis, Conclusion : We report good results through surgery of pituitary apoplexy in a clinical and endocrine outcomes. The surgery should be performed as soon as possible to be a suitable method for treating pituitary apoplexy.

• Journal of Korean Neurosurgical Society
• /
• 제52권4호
• /
• pp.404-406
• /
• 2012

The occurrence of symptomatic pituitary hemorrhage into a Rathke's cleft cyst (RCC) is extremely rare. The author reports an interesting case of intra- and suprasellar RCC presented with features of pituitary apoplexy. This 62-year-old woman suffered acute headache, mental confusion, and partial hypopituitarism. The characteristics of the magnetic resonance imaging seemed most compatible with a hemorrhagic pituitary adenoma. Transsphenoidal drainage of the cyst contents confirmed the diagnosis of hemorrhagic RCC and resolved the symptoms. All published data on this rare clinical entity are extracted and reviewed.

• Journal of Korean Neurosurgical Society
• /
• 제38권3호
• /
• pp.238-241
• /
• 2005

The main causes of pineal apoplexy are hemorrhage associated with pineal region tumors, vascular malformations, and pineal cysts. Cavernous malformations rarely occur in the pineal region, with only fifteen cases reported previously. Hemorrhage associated with cavernous malformation causes apoplectic event in the pineal region. We report two surgically treated cases of pineal hemorrhage associated with cavernous malformation and discuss the consideration in management of the pineal apoplexy.

• Journal of Korean Neurosurgical Society
• /
• 제41권4호
• /
• pp.246-247
• /
• 2007

The most common cause of isolated oculomotor nerve palsy is ischemia of the peripheral nerve caused by a disease, such as diabetes mellitus. Another common cause of isolated oculomotor nerve palsy is compression by an intracranial aneurysm, usually an posterior communicating artery aneurysm. However, it is extremely rare in the pituitary tumor. We report an unusual case of pituitary adenoma presenting with isolated oculomotor nerve palsy in the setting of pituitary apoplexy. We suggest that pituitary apoplexy should be included in the differential diagnosis of a patient with isolated oculomotor nerve palsy and early surgery should be considered for preservation of oculomotor nerve function.

• 대한한의학방제학회지
• /
• 제11권2호
• /
• pp.19-28
• /
• 2003

Sokmyeungtang was the representative prescription for Apoplexy under the rule of Tang and Song dynasty of which the cultures were thriving in the history of China. However, the clinical use of Sokmyeungtang has been gradually reduced since Geumwon dynasty of China because it was misunderstood that the dryness heat drugs of pungent in flavor and warm in property such as Ephedra, Pubescent Angelica Root, Chinese Cassia Tree-Bark, Divaricate Saposhnikovia Root, Prepared Aconite Root, Fresh Ginger, and Wildginger Herb included in the presciption for Apoplexy supplemented heat as damaging Yin flood. In fact, the drugs pungent in flavor and warm in property activate exterior and interior circulation, circulate channels and collaterals, promote blood circulation, and remove blood stasis with the side effect of relieving exterior syndrome with drugs warming channels. When treating Apoplexy with Sokmyeungtang, the cold drugs such as Gypsum, Baikai Skullcap Root, and Pueraria Root are prescribed to suppress fire of pungent dryness and to control excessive heat of people with Apoplexy as reducing the effects of hot drugs causing impairment of Yin. For treatment of Apoplexy, the above drugs accelerate blood and Qi circulation in channels and collaterals and then in necrotic tissue of human body as removing blood stasis. Consequently, these drugs improve disorders of capillary tube circulation. If Sokmyeungtang, an old prescription, is properly understood, it will be substantially helpful to all kinds of treatments in clinical cases

• Journal of Korean Neurosurgical Society
• /
• 제49권6호
• /
• pp.339-344
• /
• 2011

Objective : Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy. Methods : We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery. Results : Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037). Conclusion : This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.

• Annals of Clinical Neurophysiology
• /
• 제15권1호
• /
• pp.24-26
• /
• 2013

We encountered a case of pituitary apoplexy who presented with isolated headache and vomiting without visual disturbance or ophthalmoplegia. The cerebrospinal fluid examination was compatible with aseptic meningitis. A computed tomography revealed slightly high density in the pituitary fossa and suprasella area, but the signal change was very faint. Our case suggests that clinicians should take into account the possibility of pituitary apoplexy without visual disturbance or ophthalmoplegia, when aseptic meningitis is suspected.

• 한국한의학연구원논문집
• /
• 제2권1호
• /
• pp.26-39
• /
• 1996

The literatual study on the therapy for clearing away heat with apoplexy therapy, the result were obstained as follows. 1. In apoplexy therapy, therapy for clearing away heat is used excessive heart - fire by overacting of the five emotions, liver fire, deficiency of kidney - fluid, wind - heat. 2. The fire of aetiology of apoplexy is used therapy for clearing away eat, in aspect of viscera and bowels, divied into heart - fire, liver - fire, deficiency fie of kidney yin, wetness - phlegm of spleen heat. The treatment is clear away heart - fire, clear away liver - fire, clear away spleen - heat and sthenic water. 3. Symptom of excessiveness symptom - complex is used therapy for clearing away heat that are fever, flushed face, halitosis, heart burn, easy anger, apoplestic stroke, unconsciouness, trismus, paralysis, constipation, red tongue with yellow coat, taut - smooth pulse or full - rapid pulse and symptom of insufficiency symptom - complex that are dizziness, tinitus, blurring of vision, deficiency sleeping, dreaminess, lassitude of the loins and legs, hemiplegia, red tongue with white coat or thin - yellow coat taut - thready - rapid pulse. 4. Therapy for norish vital essence - clearing away heat is availed in excessive fire caused by deficiency of yin of the liver and kidney, therapy for break through phlegm - clearing away heat in stagnant heat therapy for waking up a patient from unconsciousness - clearing away heat in yang type sthenia - syndrom of coma of apoplexy involving viscera and bowels. 5. Commonly used recipes of therapy for clearing away heat are Yang gyolksan(凉膈散), Bang pongtongseongsan(防風通聖散), Sotongseongsan(小通聖散), Jibodan(至寶丹), Supungsungisan(搜風順氣散), Woowhangchengshimwhan(牛黃淸心丸), Chengungsekgong(川芎石膏湯), Samwhatang(三化湯) etc in excessiveness symptom- complex, and are Yukmijiwhangweon(六味地黃元), Jiwhangtang(地黃湯), Palmiji whangtang(八味地黃湯), Samultanggagam(四物湯加減) etc in insufficiency symptom - complex.

• 보험의학회지
• /
• 제26권
• /
• pp.41-53
• /
• 2007

In the course of insurance claim administration, medical experts' opinions are called medical claim reviews. They are classified into two main categories: medical verification and counsel for claim staff. Medical verification compare between product coverage and the insured's physical condition. Medical counsel for claim staff is advice for claim staff when they have a question about medical knowledge to make a claim decision. A common example of medical verification is insurance coding of pituitary apoplexy. Some clinicians have insisted that the ICD coding of pituitary apoplexy is l63 of cerebral infarction, but the exclusion criteria of I code show that neoplasm is coded as C00 to D48. Thus, pituitary apoplexy must be coded as D33. An example of medical counsel for claim staff is interpretation of some medical conditions. It is divided into UCR(usual, customary, and reasonable) assessment, assessment of causality, and so on. Disability evaluation is another subject of medical counsel for claim staff. The final claim decision must be made by claim staff because only the claim staff have the authority of claim decision. Medical claims review is only an expert's opinion.

• 동국한의학연구소논문집
• /
• 제9권
• /
• pp.127-138
• /
• 2000

잠양법(潛陽法)은 평간치법(平肝治法)의 일종으로 간양(肝陽)이 상항(上亢)해서 나타나는 두목혼훈(頭目昏暈), 수족추휵, 구안괘사, 설건어삽(舌乾語澁), 두통불지(頭痛不止), 졸연도지(猝然倒地) 등의 증상(症狀)에 쓰는 치법(治法)이며 중풍(中風)의 표실증(標實證)을 다스리는 목적으로 다용(多用)되고 있다. 중풍(中風)에서의 활용(活用)은 청대(淸代)에 이르러 본격화되었는데, 엽천사(葉天士)는 "자액식풍(滋液熄風), 유양영락(濡養營絡), 보음잠양(補陰潛陽)"을 사용하였고, 장백룡(張伯龍)은 "잠진섭납(潛鎭攝納)"하는 치료법을 사용하였다. 중풍(中風)의 병리(病理)가 본허표실(本虛標實)하므로 항상 자음(滋陰), 보수(補水)하는 치법(治法)과 상호보완적(相互補完的)으로 사용되고 있다. 잠양법(潛陽法)이 다용(多用)된 병증은 간신음허(肝腎陰虛), 풍양상요(風陽上擾)로 인한 중경락증(中經絡證)과 중장부증(中臟腑證) 중에서 양폐증(陽閉證)이며, 탈증(脫證)의 일부와 중풍일구(中風日久)로 인(因)한 전간(癲癎)에도 사용되었다. 잠양락(潛陽樂) 중 진주모(珍珠母), 석결명(石決明), 대모(玳瑁), 모려(牡蠣), 패치(貝齒), 구판(龜板), 별갑(鱉甲) 등 개류(介類)의 효력이 뛰어나고, 치방(治方)으로는 진간식풍탕(鎭肝熄風湯), 호잠환(虎潛丸), 고본단(固本丹), 복맥탕(復脈湯), 천마구등음(天麻鉤藤飮), 영양각탕(羚羊角湯) 등이 활용되고 있다.