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We report a case with calciphylaxis very rarely presenting with bilateral optic neuropathy, acral gangrene and visceral ischaemia. Bilateral papilloedaema was found in a 43 year-old female with chronic renal failure. Acral dry gangrene was observed. Pathological examination of her amputated thumb revealed calcification, thrombi, obstructive endovascular fibrotic areas in the walls of arteries. She was diagnosed with calciphylaxis. Bilateral optic neuropathy was defined secondary to calciphylaxis. Abdominal computerized tomography revealed prominent calcifications in mesenteric, spleen and renal arteries. She died eight months after the diagnosis. Calciphylaxis should be considered in the differential diagnosis of the optic neuropathy.

Pituitary adenomas account for approximately 10% of intracranial tumors and 5% are locally invasive. Cavernous sinus invasion by pituitary tumors presents mostly with cranial nerve palsies, especially involving the third, fourth and sixth cranial nerves, which is well documented in the literature. However, an isolated complaint of trigeminal neuralgia due to pituitary adenoma is an extremely rare entity with a limited number of reported cases. A 51-year-old female patient presented to our clinic with complaints of pain and numbness on the left side of face for six months, with each event lasting 5-10 seconds. No improvement was obtained with administration of carbamazepine therapy. Magnetic resonance imaging of the sellar region revealed a mass with the left cavernous sinus invasion. The patient underwent surgery via endoscopic transsphenoidal approach and after than radiosurgery with gamma-knife. The patient's complaints resolved totally after gamma-knife radiosurgery. We report herein a case of pituitary adenoma with an isolated complaint of trigeminal neuralgia. Pituitary adenomas may be presented with cavernous sinus invasion and multiple cranial nerve palsies but isolated trigeminal neuralgia due to pituitary adenoma is an extremely rare entity.

Background: The clinical importance of F-wave inversion in the diagnosis of Carpal Tunnel Syndrome (CTS) is not yet well known., Objective: This study aims to investigate the value of F-wave inversion in diagnosing CTS, and to evaluate the relationship of F-wave inversion with age, gender, diabetes mellitus, body mass index (BMI), wrist or waist circumferences., Methods: Patients (n=744) who were considered to have CTS with clinical findings were included in the study. In order to confirm the diagnosis of CTS, standard electrophysiological parameters were studied with electroneuromyography. In addition, median nerve F-wave measurements were done and we determined if F-wave inversion was present or not. Sensitivity and specificity of F-wave inversion were investigated for its value in showing CTS diagnosed by electrophysiological examination., Results: CTS diagnosis was confirmed by routine electrophysiological parameters in 307 (41.3%) patients. The number of the patients with the presence of F-wave inversion was 243 (32.7%). Sensitivity of F-wave inversion was found as 56% and specificity as 83.8%. BMI and wrist circumference values were significantly higher in patients with F-wave inversion present than those with F-wave inversion absent (p=0.0033, p=0.025 respectively)., Conclusions: F-wave inversion can be considered as a valuable electrophysiological measurement for screening of CTS.

Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18-35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36-64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference.

Objective: To report a case of pituitary adenoma apoplexy presenting with bilateral proptosis and bilateral third nerve palsy that developed after cardiovascular surgery., Clinical Presentation and Intervention: A 45-year-old man developed bilateral proptosis and bilateral third nerve palsy after a coronary artery bypass grafting operation. A pituitary macroadenoma with extension into the sphenoid sinus and cavernous sinus with bilateral involvement was resected on computed tomography scan by microscopic transsphenoidal procedure. Third nerve palsy improved partially on the first postoperative day and completely improved in the fourth month after the operation., Conclusion: This is a rare case of pituitary adenoma apoplexy that presented with bilateral third cranial nerve palsy., (Copyright © 2011 S. Karger AG, Basel.)