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Pituitary apoplexy causing acute ischemic stroke: Which treatment should be given priority
Jae-Min Ahn1, Hyuk-Jin Oh1, Jae-Sang Oh1
1Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do-Korea, South Korea.
Surgical Neurology International
|June 5, 2020
Summary
Pituitary apoplexy rarely causes acute cerebral ischemia due to internal carotid artery compression. Surgical decompression of pituitary adenoma rapidly resolved symptoms and improved cerebral blood flow.
Area of Science:
- Neurology
- Neurosurgery
- Endocrinology
Background:
- Pituitary apoplexy is a rare syndrome characterized by sudden headache, visual loss, and altered consciousness.
- Acute cerebral ischemia secondary to pituitary apoplexy is exceptionally rare.
Observation:
- A 78-year-old male with a pituitary macroadenoma presented with decreased consciousness and hemiparesis.
- Imaging revealed a pituitary macroadenoma with hemorrhage and right internal carotid artery (ICA) territory ischemia.
- Conventional angiography showed severe bilateral ICA stenosis and flow delay.
Findings:
- Microscopic tumor removal via a transsphenoidal approach was performed.
- Pathology confirmed pituitary adenoma with apoplexy.
- Post-surgery, neurological deficits resolved, and cerebral perfusion significantly improved.
Implications:
- Direct ICA compression by pituitary apoplexy can induce cerebral ischemia.
- Conventional angiography is crucial for diagnosing this rare complication.
- Prompt surgical decompression is the recommended treatment for effective management.
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