Pituitary Apoplexy Complicated by Bilateral Anterior Cerebral Artery Territory Infarctions and Optic Tract Edema: A...

Pituitary adenomas are common intracranial extra-axial neoplasms, classified based on size into microadenomas (<1 cm) and macroadenomas (>1 cm), and according to hormonal activity into functional and non-functional adenomas. Functional adenomas present with hormone-related syndromes, whereas non-functional macroadenomas typically cause symptoms due to mass effect, most commonly visual field defects. Uncommonly, pituitary adenomas may present acutely as pituitary apoplexy (PA), a medical emergency requiring prompt diagnosis and management to prevent mortality and long-term morbidity. Cerebral infarction secondary to compression of the anterior cerebral arteries is a rare complication of PA, and edema of the optic tracts is an even rarer imaging finding. We report a unique case of pituitary macroadenoma with apoplexy complicated by the simultaneous occurrence of bilateral anterior cerebral artery territory infarctions and symmetrical edema of the bilateral optic tracts. To the best of our knowledge, based on a structured literature search of PubMed, Embase, and Google Scholar, the coexistence of these two rare complications in PA has not been previously reported. This case highlights the critical role of cross-sectional imaging in identifying uncommon but serious vascular and optic pathway complications of PA, which have important implications for prognosis and management.