Cerebral Infarction Following Pituitary Apoplexy-Case Report-

Abstract

A 29-year-old man presented with lethargy, headache, high fever, and visual disturbance. Neurological examination showed mydriatic pupil, ptosis, diminished light reflex, and ophthalmoplegia on the left. Magnetic resonance (MR) imaging showed the typical findings of pituitary apoplexy, and cerebral angiography disclosed mild narrowing of the A1 segment of the left anterior cerebral artery (ACA). Transsphenoidal tumor resection was performed. Transient severe right hemiparesis occurred directly after the operation. Computed tomography demonstrated cerebral infarction in the territory of the left Heubner's and medial lenticulostriate arteries. Pituitary apoplexy followed by cerebral infarction is very rare. Vasospasm of the perforating arteries of the ACA probably caused the cerebral infarction. Subarachnoid blood or vasoactive agents released from the tumor were the most likely cause of the vasospasm. MR imaging findings of contrast enhancement around the vessels may indicate reactive processes around the vessels.

Subarachnoid Hemorrhage in a Patient With a Meningioma and an Unruptured Aneurysm

“…5) In contrast to meningiomas, pituitary apoplexy with and without SAH frequently causes vasospasm due to hypothalamic damage or vasoactive substance from adenoma, other than the SAH. 1,4,8,14,19,23) In this way, SAH due to ruptured aneurysm and meningioma have both common and different clinical features, and part of the clinical characteristics of SAH from a meningioma, including minor symptoms and vasospasms, were compatible to those found in the present case.…”

Surgical treatment of pituitary apoplexy in association with hemispheric infarction

“…Angiography, CTA, or MRA may uncover additional information, including the affected vascular territory, the patency of the intracranial vessels, and the vascular anatomy related to the tumor. This may provide further insight into the pathophysiological mechanisms involved, and determine the optimal time to perform an early decompressive neurosurgery [5].…”

Cerebral infarction caused by pituitary apoplexy: case report and review of literature

“…Bilateral cerebral arteries are theoretically speculated to be involved in cases of vasospasm, and angiography can verify the existence of vasospasm (3,9). Mechanical compression is caused by the extension of the tumor mass.…”