Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series
Bibliographic record
Abstract
Background: Pituitary tumors account for up to 15% of all intracranial tumors, 90% of which are adenomas. One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy (PA). Typically, patients with PA present emergently with a symptom cluster that may include sudden severe headache, nausea, vomiting, and new-onset impairment of the visual acuity with or without visual field defect. Occasionally, these patients may exhibit other cranial nerve palsies. These manifestations are due to the sudden increase of the tumor size due to intratumor hemorrhage and/or infarction. Usually, hypopituitarism develops as a result of gland ischemia. After patient stabilization and hormonal replacement, surgical decompression is often recommended with controversy on the timing of intervention. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following the endoscopic endonasal transsphenoidal (EETS). Study Design: Retrospective cohort, single institutional study. Methods: Institutional REB approval was attained for a retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by medical records personnel to identify cases of pituitary tumor apoplexy treated using the EETS approach. Patient characteristics, tumor type, endocrine data, and operation characteristics were then extracted from medical records pertaining to patient baseline characteristics. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results: A total of 15 cases of pituitary apoplexy were identified. Several cranial nerve deficits were present at admission. 33% of patients had a visual deficit; 47% had unilateral 3rd nerve palsy; and 27% had a unilateral 6th nerve palsy. No patients had 4th nerve palsy. Following EETS, there was significant recovery for all cranial nerve deficits. Postoperatively, 60% of patients with preoperative visual deficit had normal visual fields postoperatively and the other 40% showed improvement. For those with oculomotor nerve dysfunction preoperatively, 43% had returned to normal cranial nerve function, 57% had improvement and abducens nerve palsy resolved in 75% postoperatively, and 25% demonstrated improvement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".