Ischemic chiasmal syndrome and hypopituitarism associated with progressive cerebrovascular occlusive disease

Two interesting patients are described with unique clinical and radiographic manifestations of progressive bilateral stenosis-occlusion of the distal internal carotid arteries. Their clinical presentations, ischemic chiasmal syndrome and hypopituitarism, are extremely rare, despite extensive occlusion of the circle of Willis. In one of these patients, the configuration of collateral vessels around the optic chiasm on computed tomography (CT) was so rounded and discrete that it actually had an appearance suggesting a pituitary tumor or an aneurysm. In the second patient, a pseudoaneurysm and a very large intracerebral hematoma with a ring of contrast enhancement were the radiographic manifestations.