Pituitary apoplexy: An unusual cause of frontal lobe syndrome

Abstract

Pituitary apoplexy presenting as frontal lobe syndrome is rare. Interestingly, in our patient the frontal lobe infarct was as a result of intense anterior cerebral artery spasm consequent to nonaneurysmal subarachnoid haemorrhage. The mechanisms of cerebral infarct associated with pituitary apoplexy are discussed.

Fatal Bilateral ACA Territory Infarcts after Pituitary Apoplexy: A Case Report and Literature Review

“…Even when focal cerebral dysfunctions are uncommon, pituitary apoplexy, hemiplegia, or hemiparesis remain the commonest described presentation. 1,2,5,6 Such cases have remained on the records for nearly half of a century, but the pathophysiology remains far from understood. Documented cases of cerebral infarction in consequence to pituitary apoplexy are few (Table 1).…”

“…8 It is either ACA or internal carotid artery (ICA) that gets compromised on account of vasospasm after pituitary apoplexy. 2,5,6,9 We propose that it should always be ICA or ACA that gets mechanically obstructed on account of sellar tumor, whereas middle cerebral artery (MCA) not being a part of closed loop escapes mechanical brunt. 10 However, partial occlusion of ICA mechanically may cause MCA territory ischemia, especially when MCA is the end artery and ACA has dual supply.…”

Surgical treatment of pituitary apoplexy in association with hemispheric infarction

“…Cerebral vasospasm is attributed to SAH [27,29,30,33,34] and the release of vasoactive substances from the hemorrhagic or necrotic pituitary adenoma [5,17,28,[31][32][33] or damaged hypothalamus [17]. Among the 11 infarction patients in whom cerebral vasospasm was suspected to be the more likely etiology in the literature, only five had bilateral infarction [17,27,30,32,33].…”

“…Cerebral vasospasm could be another mechanism of cerebral infarction in these patients [5,17,[26][27][28][29][30][31][32][33][34]. Cerebral vasospasm is attributed to SAH [27,29,30,33,34] and the release of vasoactive substances from the hemorrhagic or necrotic pituitary adenoma [5,17,28,[31][32][33] or damaged hypothalamus [17].…”

Bilateral stroke following pituitary apoplexy

“…6,7 There are two possible mechanisms of cerebral ischemia following pituitary apoplexy: vasospasm due to subarachnoid hemorrhage and/or possibly the release of vasoactive compounds by the tumor, which is the most commonly reported; 8,9 or secondly direct compression of the cerebral arteries, less commonly observed, but which also applied to our patient. 7,10 For our patient, the sudden extension of the tumor mass due to the pituitary apoplexy initially led to right-sided unilateral, and later bilateral, compression of the ICA.…”