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Pituitary apoplexy is an infrequent complication of pituitary adenomas, caused by hemorrhagic or ischemic infarction in the tumor, with typical clinical presentation: severe headache of sudden onset, visual disturbances, sleep tendency or comma. Along the last ten years we have treated eight patients with pituitary apoplexy. The diagnostic was clinically established in all of them. Seven cases complained of severe headache and vomiting. Eight patients reported visual disturbances. In one case low level of consciousness and meningeal irritation were the only findings. In six cases the apoplexy was the first pituitary adenoma manifestation. MRI and CT studies demonstrated the pituitary stroke in seven patients. Surgical trans-sphenoidal decompression was performed in seven patients, requiring urgent management in only one case. All patients experienced a marked visual improvement, but there was no amelioration of endocrine preoperative disturbances in any case. We conclude that quick diagnosis, early onset of hormonal therapy and urgent or delayed trans-sphenoidal surgery, depending on clinical manifestations, constitute the principies of the appropriate treatment of pituitary apoplexy.

The objective of the study is the analysis of prognostic factors observed in the evolution of 65 patients who presented chronic subdural hematoma surgically evacuated. Morbimortality ratio corresponding to our surgical technique is also presented. A retrospective statistical analysis of epidemiologic, clinic and radiologic factors was performed. Personal background of alcoholism or coagulopathy, decrease of the level of consciousness, a lower score at the Glasgow Coma Score, a maximum thickness of the hematoma superior to 2 cm, and the respiratory and neurologic complications were found to be related to a worst prognosis. Our surgical technique showed 4.6% of mortality and 1.5% of recurrence. Detection of prognostic factors may have important implications in the selection of patients for surgery. Our small craniectomy has similar clinical outcome than other surgical methods.