Turki Elarjani1, Stephanie Chen2, Iahn Cajigas3, Brian Saway4, Samir Sur3, Jacques J Morcos3. 1. Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 2. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: chen.stephanie.h@gmail.com. 3. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. 4. Fralin Biomedical Research Institute, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Abstract
BACKGROUND: Pituitary apoplexy is defined as a sudden neurologic deficit owing to infarction or hemorrhage within the pituitary gland. We report a rare case of apoplexy manifesting with cerebral infarction due to direct compression of the internal carotid artery (ICA) and review the literature. CASE DESCRIPTION: A 31-year-old man presented with sudden-onset headache, right hemiparesis, decreased left monocular visual acuity, and a nasal visual field deficit of the left eye. Computed tomography angiography revealed evidence of a hyperdense sellar/suprasellar mass with stenosis of the cavernous and supraclinoid segments of the ICAs bilaterally. Magnetic resonance angiography performed the following day showed complete occlusion of the left cervical ICA and cystic changes of the sellar and suprasellar mass suggestive of pituitary hemorrhage. The patient underwent urgent endoscopic endonasal decompression of the mass, and postoperative digital subtraction angiography demonstrated restored flow within the left cervical ICA. CONCLUSIONS: Of 29 previously published cases of cerebral infarction due to pituitary apoplexy, the majority of cases were related to direct ICA compression. Vascular compression is associated with a high rate of mortality (24%) and should be treated urgently by surgical decompression in cases of severe or progressive neurologic symptoms.
BACKGROUND: Pituitary apoplexy is defined as a sudden neurologic deficit owing to infarction or hemorrhage within the pituitary gland. We report a rare case of apoplexy manifesting with cerebral infarction due to direct compression of the internal carotid artery (ICA) and review the literature. CASE DESCRIPTION: A 31-year-old man presented with sudden-onset headache, right hemiparesis, decreased left monocular visual acuity, and a nasal visual field deficit of the left eye. Computed tomography angiography revealed evidence of a hyperdense sellar/suprasellar mass with stenosis of the cavernous and supraclinoid segments of the ICAs bilaterally. Magnetic resonance angiography performed the following day showed complete occlusion of the left cervical ICA and cystic changes of the sellar and suprasellar mass suggestive of pituitary hemorrhage. The patient underwent urgent endoscopic endonasal decompression of the mass, and postoperative digital subtraction angiography demonstrated restored flow within the left cervical ICA. CONCLUSIONS: Of 29 previously published cases of cerebral infarction due to pituitary apoplexy, the majority of cases were related to direct ICA compression. Vascular compression is associated with a high rate of mortality (24%) and should be treated urgently by surgical decompression in cases of severe or progressive neurologic symptoms.