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Published on: April 21, 2017
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Pediatric ischemic stroke from an apoplectic prolactinoma
Rebecca A Kasl1, Joshua Hughes, Anthony M Burrows
1Vanderbilt University School of Medicine, 201 Light Hall #89, Nashville, TN, 37212, USA, Rebecca.a.kasl@vanderbilt.edu.
Summary
Pediatric pituitary apoplexy can cause stroke by compressing the internal carotid artery (ICA). This rare presentation in a teenage girl highlights the need to consider ischemic stroke in pediatric patients with pituitary tumors.
Area of Science:
- Neurology
- Pediatric Endocrinology
- Vascular Neurology
Background:
- Pituitary neoplasms and apoplexy are rare in children.
- Pituitary apoplexy rarely causes stroke via arterial compression or vasospasm in pediatric patients.
- Neurological deficits from stroke differ from typical pituitary tumor presentations.
Observation:
- A 14-year-old female presented with progressive neurological deficits, including paresthesias and weakness.
- Imaging revealed an apoplectic macroprolactinoma with acute ischemic stroke in the left anterior and middle cerebral artery territories.
- Cerebral angiography demonstrated focal compression of the left internal carotid artery (ICA).
Findings:
- This is the first reported case of pediatric pituitary apoplexy causing stroke due to ICA compression.
- The patient experienced stuttering cerebral infarction secondary to the vascular compression.
- Despite surgical decompression, the patient had transient neurological deficits that improved with rehabilitation.
Implications:
- Pituitary apoplexy should be considered in the differential diagnosis of ischemic stroke in pediatric patients.
- Non-classical symptoms like stroke can occur in pediatric pituitary apoplexy.
- Prompt recognition and management are crucial for improving outcomes in these rare cases.
