Pituitary apoplexy and vasospasm

Cardoso, Érico R.; Peterson, Eric W.

doi:10.1016/0090-3019(83)90009-5

Cited by 45 publications

(41 citation statements)

References 29 publications

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“…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.…”

Section: Sah In a Patient With A Meningioma And An Unruptured Aneurysmsupporting

confidence: 75%

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

Kanamori

Tomita

Sasaki

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Subarachnoid hemorrhage (SAH) is usually elicited by cerebrovascular disease and infrequently by brain tumors. A 64-year-old woman presented with SAH with a left petrous meningioma and an unruptured left internal carotid-posterior communicating artery (IC-PcomA) aneurysm. She suffered sudden onset of headache and nausea followed by consciousness disturbance 7 days after onset. Computed tomography (CT) revealed diffuse SAH and a tumor at the petrous portion. Angiography demonstrated a left IC-PcomA aneurysm. Under a diagnosis of a ruptured aneurysm and a coincidental meningioma, we performed neck clipping of the aneurysm. However, intraoperatively we found that the aneurysm was unruptured and we subsequently performed tumor resection. Intraoperatively we could not find the cause of SAH during resection of the meningioma. The histological diagnosis was transitional meningioma with deposition of fibrin on the surface of the tumor. The findings of initial CT and magnetic resonance imaging, and pathological results could not conclude the definitive etiology of SAH in this case.

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Section: Sah In a Patient With A Meningioma And An Unruptured Aneurysmsupporting

confidence: 75%

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

Kanamori

Tomita

Sasaki

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…The pathophysiology of vasospasm following pituitary apoplexy remains unknown. 7,9 Transdiaphragmatic rupture of the sellar adenoma or extravasation of blood from the hemorrhagic or necrotic adenoma into the subarachnoid space is a likely cause. 9 Secretion of potent vasoactive substances by the tumor may also contribute to vasospasm.…”

Section: Question For Considerationmentioning

confidence: 99%

“…7,9 Transdiaphragmatic rupture of the sellar adenoma or extravasation of blood from the hemorrhagic or necrotic adenoma into the subarachnoid space is a likely cause. 9 Secretion of potent vasoactive substances by the tumor may also contribute to vasospasm. 10 We therefore inferred that, for this patient, both mechanical compression and cerebral vasospasm were likely pathogeneses related to the stroke event.…”

Section: Question For Considerationmentioning

confidence: 99%

Clinical Reasoning: A 42-year-old man with severe headache, fever, and acute coma

et al. 2014

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A 42-year-old man underwent brain MRI at a local health facility for severe headache and was found to have a pituitary adenoma. Two days later, he presented to the emergency department of our hospital with high fever and sudden-onset coma. The patient had a history of intermittent moderate headache in the recent 8 months. No medical history of vascular risk factors was identified.On examination, his Glasgow Coma Scale score was 4/15, blood pressure was 133/86 mm Hg, and body temperature was 40°C. Blood oxygen saturation was 96% on room air and the respiratory rate was 19 breaths per minute. Neurologic examination revealed neck stiffness. The patient could open his eyes briefly and weakly in response to painful stimuli, with suspected right ptosis. His pupils were equal in diameter, and there was a right relative afferent pupillary defect. His gag reflex was present bilaterally. Spontaneous movements and motor responses to stimuli were absent. His extremities were flaccid and deep tendon reflexes were symmetric. The left Babinski sign was present. Cardiovascular examination was unremarkable. Blood tests revealed remarkable hyponatremia (126 mmol/L) and elevated leukocyte count (12.6 3 10 9 /L).Questions for consideration:

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“…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.…”

Section: Discussionmentioning

confidence: 71%