✓ The cases of 109 patients with a transcranial or transorbital stab wound are presented. Angiography in 74 patients revealed 26 vascular lesions: 11 aneurysms, five carotid-cavernous fistulas, three other arteriovenous fistulas, three occlusions, two transections, and two instances of severe vascular spasm. The following important points and pitfalls are stressed: the 30% incidence of vascular lesions, the delayed onset of these lesions and neurological signs from 1 week to several months after trauma, and the incidence of delayed intracranial hemorrhage in four of 11 cases with traumatic aneurysms. The basal location of the lesions is described, and the authors warn against the misleading clinical picture of a trivial scalp wound in the absence of a “slot” fracture, with life-threatening neural and vascular damage on the opposite side. Aggressive investigation and treatment of these lesions are advocated because of the associated high morbidity and mortality rates, especially in patients with aneurysms.
Charles F. Kieck and Jacques C. de Villiers
Patrick L. Semple, Jacques C. de Villiers, Robert M. Bowen, M. Beatriz S. Lopes, and Edward R. Laws Jr.
A retrospective analysis of a contemporary series of patients with pituitary apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome.
A retrospective analysis was performed in 59 patients treated for pituitary apoplexy at the University of Virginia Health System, Charlottesville, Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa. The patients were divided into two groups according to the histological features of their disease: one group with infarction alone, comprising 22 patients; and the other with hemorrhagic infarction and/or frank hemorrhage, comprising 37 patients. The presenting symptoms, clinical features, endocrinological status, and outcome were compared between the two groups.
The patients who presented with histological features of pituitary tumor infarction alone had less severe clinical features on presentation, a longer course prior to presentation, and a better outcome than those presenting with hemorrhagic infarction or frank hemorrhage. The endocrine replacement requirements were similar in both groups.