垂体卒中的临床及病因分析(附16例报告)

Analysis of etiology and clinic of pituitary apoplexy(a report of 16 cases).

目的分析垂体卒中的临床、影像学特点及病理生理机制。方法总结回顾 16例垂体卒中临床资料并复习相关文献。结果81.2 5 %的患者卒中前无垂体瘤病史 ,大部分无明确诱因 ,临床表现按出现频率依次为头痛、视力障碍、眼肌麻痹、脑膜刺激征、偏盲、意识障碍及锥体束征 ;8例行 CT检查 ,7例示垂体瘤 ;3例发现出血改变 ;9例行 MRI检查 ,8例示垂体瘤出血 ;13例行手术治疗。所有病例中 ,仅 3例痊愈。结论垂体卒中临床表现多样 ,易漏诊或误诊 ;对突发头痛、视力障碍、眼肌麻痹者应考虑垂体卒中可能 ,MRI检查阳性率高优于 CT扫描。

Objective To analyze the clinical and imaging characteristics as well as pathophysiology of pituitary apoplexy.Methods The clinical data of 16 cases with pituitary apoplexy were analyzed retrospectively and reviewed.Results 81.25% patients had no history of pituitary adenoma previously.Most of them had unknown causes,who were characterized of headache,visual loss,ophthalmoplegia,meningeal irritation,hemianopia,mental disorder and pyramid sign.Among 8 cases receiving CT examination,7 cases showed pituitary adenoma and 3 cases were found to have bleeding changes.Among 9 cases receiving MRI examination,8 cases showed bleeding of pituitary adenoma.Of them,13 cases were referred to operation.Only 3 cases recovered completely.Conclusion Because of the variety of clinical features,pituitary apoplexy is easy to be missed and misdiagnosed.For the patients with sudden headache,visual disorders and ophthalmoplegia,pituitary apoplexy is necessary to be considered.In addition,MRI examination shows higher positive rate than CT scan,which is prior to CT.