脑下垂体中风伪装成66岁老人无法治疗的头痛:一个案例报告
Ashley Heaney1, Negin Ceraolo1, Erin L Simon1
1Department of Emergency Medicine, Cleveland Clinic Akron General, Northeast Ohio Medical University, Akron, Ohio.
The Journal of emergency medicine
|November 1, 2025
概括
下垂体中风是一种罕见的内分泌紧急情况,提出了诊断挑战. 早期的高级成像和内分泌咨询对于及时诊断和管理这种严重疾病至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 神经学 神经学
- 紧急医疗 紧急医疗
背景情况:
- 垂体中风是一种罕见的,危及生命的内分泌紧急情况.
- 它是由垂体腺出血或心脏病发作引起的,通常伴有先前存在的腺瘤.
- 它经常模仿其他神经疾病,延迟诊断.
研究的目的:
- 为了突显下垂体中风的诊断复杂性.
- 强调在头痛综合征中需要先进的成像和早期内分泌咨询.
- 为了告知急诊医生关于识别下垂体中风的情况.
主要方法:
- 一个66岁的老人患有经常性头痛的病例报告.
- 最初的非对比CT是正常的;随后的成像显示了垂体腺瘤.
- 脑脊髓液分析显示了细胞,最初引起了人们对脑膜炎的担忧.
主要成果:
- 临床背景支持化学脑膜炎是脑下垂体脑中风的次要原因.
- 正常的初始CT成像并没有排除诊断.
- 症状的演变和CSF异常模仿脑膜炎,但可能是无菌的.
结论:
- 下垂体脑梗塞带来了诊断挑战,特别是在非诊断的初始成像.
- 紧急医生应该怀疑在严重或复发性头痛中发生垂体中风.
- 早期识别,皮质类固醇治疗和多学科护理对于预防缺陷至关重要.
相关概念视频
Hemorrhagic Stroke l: Introduction
41
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
41
Encephalitis l: Introduction
29
Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
29
Brain Abscess l: Introduction
48
A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial...
48
Increased Intracranial Pressure l: Introduction
31
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...
31
Increased Intracranial Pressure ll: Pathophysiology
43
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...
43
Cerebral Edema ll: Pathophysiology
31
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
31


