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Pituitary tumor apoplexy presenting as infective meningoencephalitis

Annachiara Cagnin1, Andrea Marcante, Enrico Orvieto

  • 1Department of Neurosciences, University of Padova Medical School, Via Giustiniani 5, 35128 Padova, Italy. annachiara.cagnin@unipd.it

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|June 2, 2011
PubMed

Insights

Pituitary apoplexy, a rare condition, can mimic infective meningoencephalitis after head trauma. Magnetic resonance imaging (MRI) aids in early diagnosis of this pituitary gland emergency.

Area of Science:

  • Neurology
  • Endocrinology
  • Radiology

Background:

  • Pituitary apoplexy is a clinical syndrome characterized by sudden onset of severe headache, visual impairment, and ophthalmoplegia, typically due to hemorrhage or infarction within the pituitary gland.
  • It can present with symptoms mimicking infectious or inflammatory central nervous system processes, leading to diagnostic challenges.

Observation:

  • An 80-year-old man presented with drowsiness, headache, fever, and meningeal irritation signs two days post-head trauma.
  • Initial suspicion was infective meningoencephalitis, prompting broad-spectrum antibiotic and antiviral treatment.
  • Brain imaging revealed an intrasellar lesion with ring enhancement and inflammatory tissue on the clivus.

Findings:

  • Cerebral CT scan identified a previously unrecognized pituitary expansive lesion.
  • Brain MRI confirmed an intrasellar lesion with significant contrast enhancement, suggestive of pituitary apoplexy.
  • Biopsy confirmed pituitary apoplexy as the diagnosis, with associated inflammatory changes potentially causing sterile meningitis.

Implications:

  • This case underscores the importance of Magnetic Resonance Imaging (MRI) in the early diagnosis of pituitary apoplexy.
  • Recognizing pituitary apoplexy is crucial as its presentation can be mistaken for infective meningoencephalitis, necessitating prompt and appropriate management.
  • Advanced neuroimaging plays a vital role in differentiating pituitary apoplexy from infectious etiologies, improving patient outcomes.

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