ReviewSurgical treatment of pituitary apoplexy in association with hemispheric infarction
Introduction
Pituitary apoplexy (PA) is a clinical syndrome caused by acute hemorrhage or infarction of the pituitary gland, and is characterized by the sudden onset of severe headache, visual impairment, ophthalmoplegia and altered mental status. The incidence of apoplexy in patients with pituitary adenoma is approximately 2–7% [1]. Cerebral infarction is a rare complication of PA, and only isolated patients have been reported. In this report, we describe a patient with PA who developed ischemic stroke and improved significantly after pituitary and hemisphere decompressive surgery. We also review similar patients reported in the literature and summarize their clinical characteristics.
Section snippets
Case report
A 23-year-old man presented with severe headache, nausea, fever and decreased visual acuity of his right eye for 1 day, followed by a sudden loss of consciousness. He had no significant previous medical history. On examination, his blood pressure was 130/80 mmHg, and body temperature was 37.1 °C. Signs of acromegaly, including frontal bossing and hand enlargement were identified, and neck stiffness was present. Spontaneous and reflex movements to painful stimuli were present in his right limbs but
Methods
We conducted a literature search in both MedLine (National Library of Medicine, Bethesda, MD, USA) and EMBASE (Elsevier, Amsterdam, The Netherlands) using the following keywords: “pituitary adenoma” OR “pituitary apoplexy”, AND “stroke” OR “cerebral infarct/infarction” OR “cerebral ischemia/ischaemia” OR “cerebral vasospasm” OR “cerebrovascular accident”. Only English language literature was included in the review. A PA and cerebral infarction diagnosis must have been based on the acute onset
Discussion
Cerebral infarction following PA is rare, with only 36 patients reported in the English language literature to date (Supp. Table 1). Only a few patients (8%) had a known history of pituitary adenoma. Some precipitating factors such as angiography, head trauma, and pituitary surgery were identified in 22% of patients (Table 1).
The most common symptoms of PA-related stroke were altered consciousness (97%), signs of intracranial hypertension, (86%), motor weakness (75%), and visual disturbance
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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Key Factors Related to Internal Carotid Artery Stenosis Associated with Pituitary Apoplexy
2021, World NeurosurgeryCitation Excerpt :Pituitary apoplexy rarely causes ICA stenosis or occlusion. Reported cases with the ICA affected by pituitary apoplexy are summarized in Table 3.5-12,21-41 The mean age of the stenotic ICA group was significantly lower than that of the normal ICA group.
Pituitary Apoplexy and Cerebral Infarction: Case Report and Literature Review
2020, World NeurosurgeryCitation Excerpt :Furthermore, acute ischemic stroke owing to compression from apoplexy trended toward higher rates of mortality than apoplexy-associated vasospasm, although this difference was not significant (35% vs. 11%, P = 0.186). Consistent with our study, Banerjee et al.7 and Zou et al.6 also found a higher mortality in the compression group compared with the vasospasm group (47% vs. 14%). The most common presenting symptoms of cerebral infarction related to pituitary apoplexy are hemiparesis, headache, and loss of consciousness.
Pituitary Apoplexy Associated with Carotid Compression and a Large Ischemic Penumbra
2016, World NeurosurgeryCitation Excerpt :He was able to ambulate with the assistance of a cane, and he reported independence in his activities of daily living. Pituitary apoplexy associated with cerebral infarction is a rare clinical entity reported 27 times in the literature.5-7 There are 2 primary mechanisms by which pituitary apoplexy may lead to cerebral infarction—compression of the intracavernous or supraclinoid ICA by an expanding sellar/suprasellar mass and vasospasm.
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These authors have contributed equally to the manuscript.