Empty sella is a radiological-anatomical entity characterised by a sella turcica filled partially or completely with cerebrospinal fluid, leading to varying degrees of pituitary flattening. Literature reports a 5% - 2...Empty sella is a radiological-anatomical entity characterised by a sella turcica filled partially or completely with cerebrospinal fluid, leading to varying degrees of pituitary flattening. Literature reports a 5% - 20% incidence of empty sella in unselected autopsies leading many to argue that its an extreme normal variant. Endocrine dysfunction varies from 8% - 25% with primary empty sella with growth hormone deficiency being most common. However isolated gonadotropin deficiency with normal sized primary empty sella are rare if any. We are reporting a case of isolated gonadotropin deficiency with primary empty sella unable to confirm or refute the association as causal or casual.展开更多
An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the ...An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. Empty sella syndrome is considered as a less common entity and is usually asymptomatic and an incidental finding. However, it can be a manifestation of increased intracranial pressure and can be occasionally severe. Compression of the pituitary gland may affect function, or traction on the optic chiasm and nerves may cause visual symptoms. An empty sella may be classified as primary when this occurs in persons who have not received pituitary radiation or pituitary surgery, while an empty sella discovered following such procedures is classified as secondary empty sella. In this report, we presented a 41-year-old multiparous patient who presented to us with symptoms of headache and left sided hemi-sensory disturbance. Examination was unrevealing except for the fact that she was obese. On evaluation, she was detected to have impaired blood sugars, dyslipidemia and vitamin insufficiency. MRI brain revealed presence of Empty Sella. Further hormonal analysis was normal. She was treated conservatively and regular follow-up was advised.展开更多
Background: Universal concern is an increased prevalence of morbidity, mortality;with improper comprehension, the globe has implemented, non evidence-based medical practice, without therapeutic indication, therapeutic...Background: Universal concern is an increased prevalence of morbidity, mortality;with improper comprehension, the globe has implemented, non evidence-based medical practice, without therapeutic indication, therapeutic protocols, policies-contraception, abortion, annihilating human race by therapy, destroying germ cells with consecutive systemic inflammatory response syndrome, associated with decreased androgen oestrogen resulting in metabolic syndrome, increased neoplasms—due to lacuna of this comprehension—cholesterol was blamed, resulting in essential fatty acids deprived diet, promoting sunflower seed oil, refined oil, lipid-lowering agents prescription like water, for the past >40 years;the tragedy of this false concept of refined oil, essential fatty acids deprived diet, [against God-ordained marvelous cell metabolism, from cholesterol] resulting in degenerative diseases, defaulted genomic repertoire, as cause and effect phenomenon in the two following morbid, fatal case presentations;contraception, abortion is the culprit and not cholesterol which is the basic life moiety of cell membrane, cell metabolism governing steroid hormones-androgen oestrogen derived from cholesterol. Case 1: 76-year-old male, vegetarian, presented with lethargy, hypotension, unexplained hyponatremia, on fludrocortisone for 2 years. MRI detected empty sella;hence hypopituitarism with cortisol deficiency, resulting in hyponatremia was considered and with hydrocortisone replacement, patient improved. Low levels of LDL, HDL, suggested chronic [>40 years] deprivation of diet containing essential fatty acids had resulted in degenerative—empty sella status with hypopituitarism. Case 2: 17-year-old girl presented with headache, vomiting, feeble pulse;6 months prior platybasia had been diagnosed and she had undergone corrective neurosurgery, to widen bilaterally, narrowed, base of skull foramina, to prevent compression on the exiting neurovascular bundles;urgent CT scan of brain confirmed significant narrowing of foramen magnum, compr展开更多
We used MRI to examine 38 healthy females and 38 female patients with empty sella syndrome. Cerebrospinal fluid flow was examined in six regions of interest, including the anterior clinoid processes, posterior clinoid...We used MRI to examine 38 healthy females and 38 female patients with empty sella syndrome. Cerebrospinal fluid flow was examined in six regions of interest, including the anterior clinoid processes, posterior clinoid processes, and 1.0 mm, 1.0 mm, 2.0 mm, --2.0 mm from the midpoint of the line between the anterior and posterior clinoid processes. The results revealed no significant differences in cerebrospinal fluid flow velocity and discharge in a single cardiac cycle, or indicators of cardiac cycles in the control group, indicating that the cerebrospinal fluid flow was relatively steady in the saddle area of the normal brain. In the empty sella syndrome group, cerebrospinal fluid hernia into the saddle area triggered a fluctuation of the anterior and posterior clinoid processes in the saddle area, while the flow in other regions in the saddle area was relatively steady this resulted in significant differences in cerebrospinal fluid flow velocity and discharge, as well as the cardiac cycle.展开更多
Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases m...Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases might be related to an underlying undiagnosed associated intracranial hyper-tension. Recognition and long-term treatment of elevated ICP is therefore critical to the successful management of these patients. Objective: To evaluate the CSF pressure in cases of spontaneous CSF rhinorrhea and to describe our same setting combined protocol to the repair of the leak, measurement and management of CSF pressure. Patients and Methods: All patients presenting to Ain Shams University Hospitals, Cairo, Egypt, with spontaneous CSF leak were included prospectively in the study. Clinical and radiologic data were collected to suspect elevated intracranial pressure. After CSF repair, CSF pressure was measured and if found to be more than 20 cmH2O, a lumboperitoneal shunt was used. Results: Twenty-seven cases, 23 women and 4 men, presented with spontaneous CSF leak. 23 patients had BMI above 30. All patients had empty sella syndrome (100%), and a meningoencephalocele was found in 13 cases (48%). CSF pressure ranged from 5 to 39 cmH2O (mean = 28.7). A pressure above 21 cmH2O was found in19 patients (70%) and subsequently had lumboperitoneal shunt in the same setting. No recurrence occurred in this subset of patients with 6 - 60 months follow-up period. Conclusion: A selective and specific same setting protocol can result in a better diagnosis and control of the accompanying elevated ICP in cases of spontaneous CSF leak. It avoids a second operative intervention, and shortens the hospital stay, with an increase in the success rate. In the same time, the smaller number of patients with normal ICP can avoid further drainage.展开更多
文摘Empty sella is a radiological-anatomical entity characterised by a sella turcica filled partially or completely with cerebrospinal fluid, leading to varying degrees of pituitary flattening. Literature reports a 5% - 20% incidence of empty sella in unselected autopsies leading many to argue that its an extreme normal variant. Endocrine dysfunction varies from 8% - 25% with primary empty sella with growth hormone deficiency being most common. However isolated gonadotropin deficiency with normal sized primary empty sella are rare if any. We are reporting a case of isolated gonadotropin deficiency with primary empty sella unable to confirm or refute the association as causal or casual.
文摘An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. Empty sella syndrome is considered as a less common entity and is usually asymptomatic and an incidental finding. However, it can be a manifestation of increased intracranial pressure and can be occasionally severe. Compression of the pituitary gland may affect function, or traction on the optic chiasm and nerves may cause visual symptoms. An empty sella may be classified as primary when this occurs in persons who have not received pituitary radiation or pituitary surgery, while an empty sella discovered following such procedures is classified as secondary empty sella. In this report, we presented a 41-year-old multiparous patient who presented to us with symptoms of headache and left sided hemi-sensory disturbance. Examination was unrevealing except for the fact that she was obese. On evaluation, she was detected to have impaired blood sugars, dyslipidemia and vitamin insufficiency. MRI brain revealed presence of Empty Sella. Further hormonal analysis was normal. She was treated conservatively and regular follow-up was advised.
文摘Background: Universal concern is an increased prevalence of morbidity, mortality;with improper comprehension, the globe has implemented, non evidence-based medical practice, without therapeutic indication, therapeutic protocols, policies-contraception, abortion, annihilating human race by therapy, destroying germ cells with consecutive systemic inflammatory response syndrome, associated with decreased androgen oestrogen resulting in metabolic syndrome, increased neoplasms—due to lacuna of this comprehension—cholesterol was blamed, resulting in essential fatty acids deprived diet, promoting sunflower seed oil, refined oil, lipid-lowering agents prescription like water, for the past >40 years;the tragedy of this false concept of refined oil, essential fatty acids deprived diet, [against God-ordained marvelous cell metabolism, from cholesterol] resulting in degenerative diseases, defaulted genomic repertoire, as cause and effect phenomenon in the two following morbid, fatal case presentations;contraception, abortion is the culprit and not cholesterol which is the basic life moiety of cell membrane, cell metabolism governing steroid hormones-androgen oestrogen derived from cholesterol. Case 1: 76-year-old male, vegetarian, presented with lethargy, hypotension, unexplained hyponatremia, on fludrocortisone for 2 years. MRI detected empty sella;hence hypopituitarism with cortisol deficiency, resulting in hyponatremia was considered and with hydrocortisone replacement, patient improved. Low levels of LDL, HDL, suggested chronic [>40 years] deprivation of diet containing essential fatty acids had resulted in degenerative—empty sella status with hypopituitarism. Case 2: 17-year-old girl presented with headache, vomiting, feeble pulse;6 months prior platybasia had been diagnosed and she had undergone corrective neurosurgery, to widen bilaterally, narrowed, base of skull foramina, to prevent compression on the exiting neurovascular bundles;urgent CT scan of brain confirmed significant narrowing of foramen magnum, compr
基金Science and Technology Project of Longgang District in Shenzhen, No. YW2007044, YLL2010064
文摘We used MRI to examine 38 healthy females and 38 female patients with empty sella syndrome. Cerebrospinal fluid flow was examined in six regions of interest, including the anterior clinoid processes, posterior clinoid processes, and 1.0 mm, 1.0 mm, 2.0 mm, --2.0 mm from the midpoint of the line between the anterior and posterior clinoid processes. The results revealed no significant differences in cerebrospinal fluid flow velocity and discharge in a single cardiac cycle, or indicators of cardiac cycles in the control group, indicating that the cerebrospinal fluid flow was relatively steady in the saddle area of the normal brain. In the empty sella syndrome group, cerebrospinal fluid hernia into the saddle area triggered a fluctuation of the anterior and posterior clinoid processes in the saddle area, while the flow in other regions in the saddle area was relatively steady this resulted in significant differences in cerebrospinal fluid flow velocity and discharge, as well as the cardiac cycle.
文摘Background: Spontaneous CSF leak represents less frequent cause of CSF leak, but cases are more difficult to control, with the highest failure rate and recurrence despite adequate repair. The problems in these cases might be related to an underlying undiagnosed associated intracranial hyper-tension. Recognition and long-term treatment of elevated ICP is therefore critical to the successful management of these patients. Objective: To evaluate the CSF pressure in cases of spontaneous CSF rhinorrhea and to describe our same setting combined protocol to the repair of the leak, measurement and management of CSF pressure. Patients and Methods: All patients presenting to Ain Shams University Hospitals, Cairo, Egypt, with spontaneous CSF leak were included prospectively in the study. Clinical and radiologic data were collected to suspect elevated intracranial pressure. After CSF repair, CSF pressure was measured and if found to be more than 20 cmH2O, a lumboperitoneal shunt was used. Results: Twenty-seven cases, 23 women and 4 men, presented with spontaneous CSF leak. 23 patients had BMI above 30. All patients had empty sella syndrome (100%), and a meningoencephalocele was found in 13 cases (48%). CSF pressure ranged from 5 to 39 cmH2O (mean = 28.7). A pressure above 21 cmH2O was found in19 patients (70%) and subsequently had lumboperitoneal shunt in the same setting. No recurrence occurred in this subset of patients with 6 - 60 months follow-up period. Conclusion: A selective and specific same setting protocol can result in a better diagnosis and control of the accompanying elevated ICP in cases of spontaneous CSF leak. It avoids a second operative intervention, and shortens the hospital stay, with an increase in the success rate. In the same time, the smaller number of patients with normal ICP can avoid further drainage.
