Simon Sumu, Torpy David, Brophy Brian, Blumbergs Peter, Selva Dinesh, Crompton John L
South Australian Institute of Ophthalmology, Level 8, Royal Adelaide Hospital, North Terrace, Adelaide-5000, Australia.
N Z Med J. 2011 May 27;124(1335):52-9.
To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy.
Retrospective chart review.
23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months). At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence of precipitating factors and timing of surgery did not have an impact on neuro-ophthalmic recovery.
Pituitary apoplexy should be considered in any patient with abrupt onset of neuro-ophthalmic deficits. Prompt medical and surgical management is lifesaving and can lead to significant improvement in visual and cranial nerve deficits.
报告垂体卒中患者的神经眼科表现及预后。
回顾性病历审查。
共纳入23例患者（17例男性，平均年龄54.1岁，范围23 - 86岁）。22例患者起病急骤；1例患者为亚临床表现。头痛是最常见的首发症状（82.6%，19/23）。超过四分之三的患者存在神经眼科表现（82.6%，19/23）。就诊时，分别有55%（11/20）、47.6%（10/21）和60.9%（14/23）的患者出现视力下降、视野缺损和脑神经麻痹。4例患者采用保守治疗，18例患者接受手术治疗；1例患者在就诊后不久死亡。中位随访期为10.5个月（22例患者，范围0.2 - 168个月）。在末次随访时，视力下降的患者（8/8）和眼肌麻痹的患者（13/13）全部改善，视野缺损的患者中81.8%（9/11）改善。年龄、性别、诱发因素的存在及手术时机对神经眼科恢复无影响。
任何突发神经眼科缺损的患者均应考虑垂体卒中。及时的药物和手术治疗可挽救生命，并能显著改善视力和脑神经缺损。
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