Hemorrhagic pituitary adenoma manifesting as transient global amnesia

Transient Global Amnesia in a Patient with Pituitary Adenoma: Causal or Chance Association?

A 65-year-old man with no underlying medical history visited the neurology department due to transient amnesia lasting for about 8 h. During the amnesia episode, he was alert but showed repetitive questioning. The episode fulfilled the diagnostic criteria for transient global amnesia (TGA). On workups for excluding alternative diagnoses, the brain magnetic resonance imaging revealed a 3 × 6 cm-sized hemorrhagic pituitary tumor extending to the left medial temporal lobe and anterior hippocampus. The electroencephalogram revealed intermittent slowing in the left temporal region with normal backgrounds. The tumor was surgically removed and pathologically proven to be a nonfunctioning adenoma. At 6 months postoperatively, no complication or new amnestic episode occurred. Thus, our case had a typical TGA as the first manifestation of a pituitary tumor. There were no features of epileptic amnesia. Transiently altered flow status from a mass effect in the memory-eloquent area might be the possible pathogenic mechanism underlying the TGA though there still remains a probability of chance concurrence of TGA and tumor.

Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

INTRODUCTION

Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.

SUBJECTS AND METHODS

All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.

RESULTS

Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40-130) and median prolactin = 15,715 ng/ml (n < 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.

CONCLUSION

Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.

Transient global amnesia and brain tumour: chance concurrence or aetiological association? Case report and systematic literature review

We report a patient presenting with episodes of transient amnesia, some with features suggestive of transient global amnesia (TGA), and some more reminiscent of transient epileptic amnesia. Investigation with neuroimaging revealed an intrinsic lesion in the right amygdala, with features suggestive of low-grade neoplasia. We undertook a systematic review of the literature on TGA and brain tumour. Fewer than 20 cases were identified, some of which did not conform to the clinical diagnostic criteria for TGA. Hence, the concurrence of brain tumour and TGA is very rare and of doubtful aetiological relevance. In some brain tumour-associated cases, epilepsy may be masquerading as TGA.

Transient global amnesia as a revealing sign of giant transtentorial meningioma: case report and review of the literature

Since 1974, only 14 papers in MEDLINE-indexed journals have linked transient global amnesia (TGA) to a brain tumor. Among these, two described the entity of transient epileptic amnesia (TEA), whereas most reports lacked the functional investigations that might differentiate the two conditions. Only six cases have linked TGA or TEA to a meningioma, and none of them were transtentorial. We report the case of a 75-year-old woman who presented with one episode of TGA as a sole symptom of a giant transtentorial meningioma in the right hemisphere. A sudden attack of TGA with a rather typical clinical presentation--anterograde amnesia with selective retrograde features that lasted for a few hours, with stereotypic questions, no associated symptoms or neurological impairment, and no recurrence--occurred while she was at home; this was witnessed by her husband. The neurological examination was unremarkable, with the exception of a slight left homonymous superior quadrantonopia. Brain imaging (computed tomography and magnetic resonance imaging) showed a huge meningioma originating from the right tentorium, extending from the cerebellar hemisphere to the midst of the temporal lobe. An electroencephalogram did not reveal temporal spikes. The tumor was completely excised, and she has remained asymptomatic for 6 months. Although TGA is generally a functional entity, without an organic substrate to prompt surgical sanction, a full investigation may be warranted to rule out the possibility of a silent intracranial tumor.

Transient global amnesia following a transoceanic flight

Transient global amnesia (TGA) is the abrupt onset of temporary anterograde amnesia without any focal neurological features. It is a benign condition and is completely reversible in most cases. However, the sudden occurrence of memory impairment can be especially alarming to an individual who has recently arrived in an unfamiliar setting. The cause of TGA remains unknown. Reported here is the unusual occurrence of TGA in a man following the completion of an international airplane flight. Possible etiologies of the episode are considered.