Spinal AVMs

Coup de poignard of Michon. Sudden acute stabbing back pain from rupture of spinal AVM - corollary of thunderclap headache of ruptured intracranial aneurysm. https://radiopaedia.org/articles/coup-de-poignard-of-michon?lang=us

Foix-Alajouanine syndrome. Gradual but quickly progressive weakness, myelopathy, from venous hypertension in the setting of a spinal AVM. https://radiopaedia.org/articles/foix-alajouanine-syndrome?lang=us

Skull Base

How is pituitary carcinoma diagnosed in 2023?

• Purely clinically. It is not a histological diagnosis. It is diagnosed based on the presence of distal recurrences in the brain (eg posterior fossa) or spine.

After prolactinoma resection the prolactin level decreases substantially but remains elevated 24 hours after surgery. What does this say about likely extent of resection? 

• There is likely some residual. The half life of prolactin is very short and you would expect to see the level normalize quickly postop if you got a GTR