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Published on: January 17, 2018
Unusual bifrontal cerebral infarction related to pituitary apoplexy. An uncommon presentation and literature review
Tiago S F Holanda1, Isnara Mara Freitas Pimentel2, Paulo Victor Ferreira Gomes Araujo1
1Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil.
Background:
Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms are headache, visual impairment, ophthalmoplegia, and hypopituitarism. The relationship between stroke and PA is uncommon and two mechanisms are described: vascular compression and vasospasm.
Case Report:
A 65-old-year man presented with severe headache, vomiting, ophthalmoplegia, and somnolence. Radiological examinations showed an expansive sellar and suprasellar lesion with a heterogeneous signal, besides Diffusion-weighted imaging (DWI) restriction in the bifrontal area was present. The findings were compatible with PA and stroke.
Conclusion:
PA leading to cerebral infarction is a rare condition that presents high morbidity and mortality levels. There are two main mechanisms related: direct arterial compression and arterial vasospasm. The cases must be conducted as neuroendocrinological emergencies and surgical management is a key point to better the prognosis of patients.
