ergoline and Subarachnoid-Hemorrhage

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

Topics: Aneurysm, Ruptured; Cabergoline; Carotid Artery Diseases; Carotid Artery, Internal; Cavernous Sinus; Ergolines; Humans; Male; Middle Aged; Pituitary Neoplasms; Prolactinoma; Skull Base; Subarachnoid Hemorrhage; Treatment Outcome

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

Topics: Aneurysm, Ruptured; Antineoplastic Agents; Cabergoline; Carotid Artery, Internal; Cavernous Sinus; Cerebral Angiography; Ergolines; Humans; Male; Middle Aged; Prolactinoma; Rupture, Spontaneous; Skull Base; Subarachnoid Hemorrhage

Pituitary carcinomas are very rare tumors, nearly always presenting as widely invasive masses, although the hallmark of these lesions is the finding of distant metastases. One third of reported cases are prolactin (PRL)-secreting tumors. We report the case of a fatal pituitary carcinoma evolving within 4 years from a PRL-secreting microadenoma. A 22-year-old woman presented because of galactorrhea. Evaluation of the patient disclosed slight hyperprolactinemia and magnetic resonance imaging (MRI) showed a 7-mm intrapituitary lesion, which responded to treatment with cabergoline. About 4 years after the first evaluation she developed sudden headache, ptosis, and diplopia in the right eye. MRI disclosed the growth of a large pituitary mass, invading the right cavernous sinus. Despite two trans-sphenoidal surgical procedures followed by gamma-knife radiosurgery, the patient showed rapid local progression of the tumor and the occurrence of new lung lesions, probably of metastatic nature. The patient died 7 months after the development of her first neurological symptoms because of tumor apoplexy and subsequent subarachnoid hemorrhage. This case represents the first documented rapid evolution from a microprolactinoma initially responding to dopamine agonists to a fatal pituitary carcinoma.

Topics: Adult; Cabergoline; Carcinoma; Combined Modality Therapy; Disease Progression; Dopamine Agonists; Drug Resistance; Ergolines; Fatal Outcome; Female; Humans; Octreotide; Pituitary Apoplexy; Pituitary Neoplasms; Prolactinoma; Radiosurgery; Subarachnoid Hemorrhage

The effect of the alpha-adrenoblockers, nicergoline (N) and dihydroergotoxin (DHET), on the cerebral vessels and the systemic hemodynamics was studied in 152 patients with acute and chronic vascular diseases of the brain. It was established that the hypotensive action of alpha-blockers was the greater the higher was the initial arterial hypertension. REG conducted during an hour after the intravenous administration of N and DHET revealed an increase in the pulse blood filling and an improvement of the arterial tone. Changes in vascular resistance were heterogeneous. Both drugs induced the venous outflow but there were no signs of venous hypotension. An improvement in the systemic and cerebral hemodynamics correlated with clinical improvement.

Topics: Blood Pressure; Brain Ischemia; Cerebrovascular Circulation; Cerebrovascular Disorders; Dihydroergotoxine; Ergolines; Humans; Nicergoline; Plethysmography, Impedance; Subarachnoid Hemorrhage; Vascular Resistance