Cerebral vasospasm as a consequence of pituitary apoplexy: illustrative case

Alsayadi, S; Ochoa-Sanchez, Rafael; Moldovan, Ioana; Alkherayf, Fahad

doi:10.3171/case22349

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Nevertheless, a recent study described a rare case of cerebral vasospasm, which is a well-known complication of aneurysmal SAH, caused by pituitary apoplexy. [2] Thus, it is possible that SAH accompanied by pituitary apoplexy may accelerate symptomatic hydrocephalus in LOVA patients.…”

Section: Discussionmentioning

confidence: 99%

Secondary normal pressure hydrocephalus following pituitary apoplexy: a case report.

Tomita,

Fukuda,

Kobasi

et al. 2024

Preprint

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Introduction: Although secondary normal pressure hydrocephalus (sNPH) can occur in various central nervous system diseases, there are no reports of sNPH caused by pituitary lesions. Herein, we present a unique case of sNPH caused by pituitary apoplexy. Case Presentation: A 70-year-old man was transferred to our hospital because of sudden onset of headache and loss of consciousness. Cerebrospinal fluid (CSF) test showed slightly elevated cell counts and protein levels, but a negative CSF culture test. Magnetic resonance imaging showed a dumbbell-like cystic lesion with hemorrhagic changeat the sella turcica. From the above, the patient was diagnosed with aseptic meningitis caused by pituitary apoplexy. Pituitary hormone replacement therapy was undertaken and his symptoms fully improved. However, 2 months later he complained of a gait disturbance and incontinence that had gradually appeared. Brain imaging with computed tomography showed no ventricular enlargement compared with initial images, although the lateral ventricles were slightly enlarged. As a CSF drainage test improved his symptoms temporarily, sNPH with possible longstanding overt ventriculomegaly in adults (LOVA) background was suspected. We performed a lumbo-peritoneal shunt placement, which improved his symptoms. Conclusions: This case suggestes that sNPH can develop even after a small subarachnoid hemorrhage caused by a pituitary apoplexy in LOVA patients. If the aqueduct of Silvius is open, sNPH with a LOVA background can be successfully treated with lumbo-peritoneal shunt placement.

show abstract

Section: Discussionmentioning

confidence: 99%

Secondary normal pressure hydrocephalus following pituitary apoplexy: a case report.

Tomita,

Fukuda,

Kobasi

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Nevertheless, a recent study described a rare case of cerebral vasospasm, which is a well-known complication of aneurysmal SAH, caused by pituitary apoplexy. [ 2 ] Thus, SAH accompanied by pituitary apoplexy may accelerate symptomatic hydrocephalus in LOVA patients.…”

Section: Discussionmentioning

confidence: 99%

Secondary normal pressure hydrocephalus following pituitary apoplexy: A case report

Tomita,

Fukuda,

Kobashi

et al. 2024

Surgical Neurology International

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Background: Although secondary normal pressure hydrocephalus (sNPH) can occur in various central nervous system diseases, there are no reports of sNPH caused by pituitary lesions. Herein, we present a unique case of sNPH caused by pituitary apoplexy. Case Description: A 70-year-old man was transferred to our hospital because of a sudden onset of headache and loss of consciousness. The cerebrospinal fluid (CSF) test showed slightly elevated cell counts and protein levels but a negative CSF culture test. Magnetic resonance imaging showed a dumbbell-like cystic lesion with hemorrhagic change at the sella turcica. From the above, the patient was diagnosed with aseptic meningitis caused by pituitary apoplexy. Pituitary hormone replacement therapy was undertaken, and his symptoms fully improved. However, two months later, he complained of a gait disturbance and incontinence that had gradually appeared. Brain imaging with computed tomography showed no ventricular enlargement compared with initial images, although the lateral ventricles were slightly enlarged. As a CSF drainage test improved his symptoms temporarily, sNPH with possible longstanding overt ventriculomegaly in adults (LOVA) background was suspected. We performed a lumboperitoneal shunt (LPS) placement, which improved his symptoms. Conclusion: This case suggests that sNPH can develop even after a small subarachnoid hemorrhage caused by a pituitary apoplexy in LOVA patients. If the aqueduct of Sylvius is open, sNPH with a LOVA background can be successfully treated with LPS placement.

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Neuro-ophthalmic evaluation and management of pituitary disease

Wang,

Meyer,

Danesh-Meyer

2024

Eye

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Neuro-ophthalmic evaluation is a crucial component of the diagnostic and prognostic assessment of pituitary disease and compressive chiasmopathy, and can inform the timing of vision-restoring tumour resection surgery. The most common disease affecting the pituitary with neuro-ophthalmic implications are pituitary adenomas. Neuro-ophthalmic manifestations include decreased vision, abnormal colour vision and impaired visual field or diplopia. The recognition of these syndromes is critical to achieve early diagnosis and treatment and to improve prognosis. The pattern of vision loss in chiasmal compression is determined by the anatomical relationship between the pituitary lesion and optic chiasm, and potential visual field defects include bitemporal deficits, junctional scotomas, monocular cecocentral defects, and incongruous homonymous hemianopias. Rarer neuro-ophthalmic manifestations of pituitary disease include ophthalmoplegia, nystagmus, and obstructive hydrocephalus. There is growing evidence that demonstrates the strong diagnostic utility of optical coherence tomography (OCT) parameters in detecting the presence of compressive chiasmopathy, as well as the prognostic ability to predict the rate and degree of visual recovery following decompression surgery. Long-term neuro-ophthalmic monitoring is critical for detecting delayed vision loss following resection surgery, which may represent tumour recurrence or secondary complications.

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Cerebral vasospasm as a consequence of pituitary apoplexy: illustrative case

Cited by 3 publications

References 27 publications

Secondary normal pressure hydrocephalus following pituitary apoplexy: a case report.

Secondary normal pressure hydrocephalus following pituitary apoplexy: a case report.

Secondary normal pressure hydrocephalus following pituitary apoplexy: A case report

Neuro-ophthalmic evaluation and management of pituitary disease

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