Onesti S T, Wisniewski T, Post K D
Department of Neurosurgery, Columbia University, New York, New York.
Neurosurgery. 1990 Jun;26(6):980-6.
A retrospective review of 16 consecutive patients with pituitary apoplexy treated over a 10-year period is reported. Eight men and 8 women (mean age, 48 years) underwent transsphenoidal decompression after an average duration of symptoms of 19 days. The diagnosis of pituitary apoplexy was made by the sudden onset of headache (88%), nausea (56%), or meningismus (13%), with or without visual disturbances (75%), in the setting of a sellar tumor on computed tomographic or magnetic resonance imaging scans. Thirteen of 16 patients showed significant improvement of symptoms after surgery (average follow-up, 2.5 years). In addition, 5 patients with clinically silent yet extensive pituitary hemorrhage were treated. Although extensive pituitary hemorrhage often produced fulminant apoplexy, it also presented insidiously over many days with few, if any, clinical signs. Rapid diagnosis, endocrine replacement, and transsphenoidal decompression constituted effective therapy. Magnetic resonance imaging (after at least 12 hours of symptoms) was superior to computed tomography in detecting hemorrhage.
本文报告了对10年间连续治疗的16例垂体卒中患者的回顾性研究。8名男性和8名女性（平均年龄48岁）在症状出现平均19天后接受了经蝶窦减压术。垂体卒中的诊断依据为在计算机断层扫描或磁共振成像扫描显示鞍区肿瘤的情况下，突然出现头痛（88%）、恶心（56%）或颈项强直（13%），伴或不伴有视觉障碍（75%）。16例患者中有13例术后症状有显著改善（平均随访2.5年）。此外，还治疗了5例临床无症状但垂体广泛出血的患者。虽然垂体广泛出血常导致暴发性卒中，但也可能在数天内隐匿出现，几乎没有临床体征。快速诊断、内分泌替代治疗和经蝶窦减压术构成了有效的治疗方法。磁共振成像（症状出现至少12小时后）在检测出血方面优于计算机断层扫描。
