title: [Confused dream-like state and hypophyseal apoplexy: neurovascular hypothesis].
abstract: BACKGROUND
  Pituitary apoplexy has been defined classically as a nosologic syndrome of predominant headache, visual deficits and decreased level of consciousness, but there are not any psychopathological associations described in the scientific literature directly related to it. The disorder of sensorium or arousal is a variable sign, with a rank of features from moderated lethargy to coma and stupor, revealing a torpid evolution.
  
  
  METHODS
  We present a case with behavioral changes, mental dissociation and temporal illusions. In turn, infections or endocrinologic morbidity are rejected; it is estimated a nosological difference of confused-oneiric psychosis in a neurovascular context.
  
  
  CONCLUSIONS
  In the neuroanatomical context, an acceptable hypothesis for this emotional semiology would be the effect of diaschisis on hypothalamic and hypophyseal fibers in connection with limbic system/hippocampus. There could be, in addition, a demonstration of the relationship between this hypophyseal-hypothalamic system and the rhinencephalic or vegetative brain, the seat of behavioral activity.
authors.affiliation: Servicio y Cátedra de Neurología, Hospital de Cruces, Vizcaya, España.
authors.forename: S G
authors.initials: SG
authors.lastname: Echebarria-Mendieta
mesh_terms: D003221:Confusion / Q000175:diagnosis / Q000209:etiology*; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000175:diagnosis / Q000209:etiology*; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis*; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000209:etiology*