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Vol. 22. Issue 6.
Pages 558-561 (January 2011)
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Vol. 22. Issue 6.
Pages 558-561 (January 2011)
Neumoencéfalo a tensión causado por el tratamiento con cabergolina en un paciente con prolactinoma invasivo gigante. A propósito de un caso
Cabergoline-induced tension pneumocephalus in a patient with giant invasive prolactinoma. Case report
J. Castro-Castro
Corresponding author
juliancastrocastro@yahoo.es

Correspondencia: Servicio de Neurocirugía. Complexo Hospitalario de Ourense. Ramón Puga. 52–54. 32005. Ourense. España. Fax: 988385551.
, A. Pinzón-Millán, A. Pastor-Zapata
Servicios de Neurocirugía. Complejo Hospitalario de Ourense. Ourense. España
J.A. Torre-Eiriz*
* Otorrinolaringología. Complejo Hospitalario de Ourense. Ourense. España
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Resumen

El tratamiento de los pacientes con prolactinomas consiste principalmente en el uso de agonistas dopaminérgicos (AD). Cuando estos fármacos reducen el tamaño de prolactinomas invasivos, los espacios intra y extracraneal pueden llegar a comunicarse. El neumoencéfalo y la fístula de líquido cefalorraquídeo (LCR) han sido descritos.

Un paciente varón de 56 años acude al servicio de urgencias con un síndrome de hipertensión intracraneal. Tras haber sido diagnosticado de un prolactinoma invasivo, había sido tratado con cabergolina durante 2 semanas. El TC craneal mostró neumoencéfalo frontal interhemisférico en la cavidad que ocupaba previamente el tumor, y un defecto óseo en el suelo de la silla turca. Se realizó evacuación del pneumoencéfalo, reparación de los defectos craneales y meníngeos y exéresis subtotal del tumor. Se revisa la literatura, los posibles mecanismos fisiopatológicos, modos de prevención y tratamiento.

Palabras clave:
Cabergolina
Fístula de líquido cefalorraquídeo
Neumoencéfalo
Prolactinoma
Abreviaturas:
AD
FSH
LCR
LH
RM
TC
Summary

Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported.

A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment.

Key words:
Cabergoline
Cerebrospinal fluid leak
Pneumocephalus
Prolactinoma

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