No shinkei geka. Neurological surgery
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Lymphocytic hypophysitis is a rare autoimmune disease of the pituitary gland mimicking pituitary macroadenoma on magnetic resonance imaging (MRI). We encountered a 32-year-old female who presented with a typical pituitary macroadenoma causing sudden on-set of visual disturbance during her second pregnancy. She underwent an endonasal-transsphenoidal resection of the mass diagnosed as a non-secreting pituitary macroadenoma after a cesarean operation. ⋯ Histopathological examination showed diffuse infiltrate of non-specific lymphocytes. Postoperatively, prednisolone was given for two weeks, her visual disturbance improved with radiologically marked shrinking of the lesion. This case illustrates the difficulty of differentiation of lymphocytic hypophysitis from pituitary macroadenoma, and we discuss the clinical features and the management of this disease.
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A case of ruptured true posterior communicating artery aneurysm with neurogenic pulmonary edema is presented. A 31-year-old male suffered the sudden onset of unconsciousness with respiratory dysfunction and pinkish foamy sputum. Computed tomography demonstrated diffuse subarachnoid hemorrhage and chest roentgenogram disclosed pulmonary edema. ⋯ He suffered multiple cerebral infarctions caused by vasospasm but he atlained a full recovery after 7 months. The follow-up angiogram showed complete obliteration of the aneurysm. This case report suggests that endovascular treatment with lumbar drainage is useful for severe aneurysmal SAH complicated with pulmonary edema in the acute stage.