Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

Abstract

Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.

Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report

“…The optimal timing of surgery was under debate [ 15 ]. Some articles were in favor of early decompression surgery, as it may counter visual impairment, ICA blood flow and brain edema [ [16] , [17] , [18] ]. Endoscopic transsphenoidal surgery and craniotomy were among surgery options.…”

“…Endoscopic transsphenoidal surgery and craniotomy were among surgery options. Endoscopic transsphenoidal surgery patients had a lower mortality rate and improved better [ 17 ]. In our patient, the left ICA was compressed by the pituitary tumor causing cerebral infarction.…”

Pituitary Apoplexy, Meningitis and Cerebral Infarction - A Perplexing Trifecta

“…In a recent literature review of cerebral infarction associated with PA, the pathogenesis was reported as being due to direct intracranial vascular compression or vasospasm, either separately or together. 14 Mechanical compression was most commonly unilateral, but rarely bilateral. Vasospasm has been postulated as being due to vasoactive substances being released by the tumor itself or by the compressed hypothalamus, or due to subarachnoid hemorrhage (SAH) from the tumor.…”

Cerebral Infarction from Compression of the Internal Carotid Artery - A Rare Presentation of Pituitary Apoplexy

“…Its aetiology is either haemorrhage or infarction within the adenoma. Patients can present with varying signs and symptoms, most commonly including headaches, nausea, diminished visual acuity, temporal visual field cut, ophthalmoparesis and impaired mental status [1][2][3][4][5]. Risk factors for PA includes bromocriptine withdrawl or initiation, head trauma, intracranial hypertension, hormone stimulation of the gland (for example during pregnancy), large tumor, cavernous sinus invasion and anticoagulation [4,5].…”

“…The apoplectic tumor secrets vasoactive substance which then enters the subarachnoind space and causes vasospams. Some authors believe both mechanisms are responsible [2,3,6].…”