Spontaneous intracranial hypotension with pituitary adenoma

Abstract

IntroductionAcquired intracranial hypotension is more frequent than spontaneous ones and they are usually due to a lumbar puncture, spinal anaesthesia and neurosurgical operations. Spontaneous intracranial hypotension (SIH) was first described by Schaltenbrand in 1938 [1]. SIH is a rare phenomenon characterised by postural headache, neck pain, nausea/vomiting and findings of cranial neuropathies. Although it was already a well known clinical entity, the diagnostic value of imaging was better valued after magnetic resonance imaging (MRI) became widely available. The characteristic MRI findings are diffuse intracranial pachymeningeal thickening and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. However, SIH associated with pituitary adenoma has not been previously reported. In this paper, a SIH case with pituitary adenoma and associated subsequent subdural haemorrhage is presented. Case reportA 41-year-old woman was presented to our hospital with a one-year history of severe headache, J Headache Pain (2006) 7:47-50 DOI 10.1007 Spontaneous intracranial hypotension with pituitary adenoma

Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes

“…Thus, many patients with SIH have pituitary engorgement and upward bowing of the diaphragm sellae. [79][80][81] These findings may lead to misdiagnosis as a nonfunctioning pituitary adenoma (Fig 7). 82,83 Furthermore, due to the uniquely dense hypophyseal portal system, venous congestion can predispose patients to apoplexy, a rare-but-emergent hemorrhage, or infarction of the pituitary gland.…”

Pituitary enlargement in spontaneous intracranial hypotension—a diagnostic pitfall

“…Other unusual pituitary manifestations of SIH include hemorrhage [ 9 ] and partial insufficiency [ 7 ]. Interestingly, an unusual case of SIH associated with a pituitary macroadenoma and subdural hemorrhage has also been described [ 5 ].…”