Perirolandic Sparing and Pituitary Apoplexy in Adult Brain with Global Hypoxia

Abstract

Global hypoxia in adult brain usually manifests as ischemic lesions in watershed territories. Acute profound hypoxia involves the cortex especially the perirolandic area, white matter and deep grey matter. Perirolandic sparing in adult global hypoxia is not described in literature. Few cases of perirolandic sparing are described in conditions like anoxia in term infants in the post-neonatal period and hepatic encephalopathy. We report a case of global hypoxia in adult brain with perirolandic sparing and unique association with pituitary apoplexy. It is well known that the "diving reflex" redistribution of cerebral blood flow to the high metabolically active regions occurs when the hypoxic insult is prolonged and partial. The perirolandic sparing in our case could be explained by this phenomenon, wherein the patient acutely developed hypoxia, which was profound and prolonged but not prolonged enough for deep grey matter sparing.

Pituitary Apoplexy: A Rare Cause of Cerebral Infarction

“…The predisposing factors include diabetic ketoacidosis, postpartum hemorrhage, anticoagulant therapy, trauma, radiation therapy, bromocriptine administration and endocrine stimulation tests [10][11][12][13] . An extensive literature search yielded 19 cases of cerebral infarction associated with pituitary apoplexy 2,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Pituitary apoplexy can cause narrowing of the intracranial vessels by either mechanical obstruction due to mass effect or by vasospasm resulting in cerebral infarction.…”