Pituitary adenoma apoplexy caused by rupture of an anterior communicating artery aneurysm: case report and literature review

Xu, Kan; Yuan, Yongjie; Zhou, Ji; Yu, Jinlu

doi:10.1186/s12957-015-0653-z

Cited by 18 publications

(26 citation statements)

References 15 publications

(20 reference statements)

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“…Aneurysms from the cavernous segment of internal carotid artery, anterior or posterior communicating artery may extend into the sellar or suprasellar space (57)(58)(59). The aneurysm itself may cause headaches, however patients with thrombosis or rupture will report acute pain.…”

Section: Sellar Aneurysmmentioning

confidence: 99%

“…Aneurysms with repeat/recurrent hemorrhage and thrombosis may acquire a heterogeneous "onionskin" appearance. CT angiography ( Figure 11A,B) or DSA (digital subtraction angiography) is required to confirm diagnosis (57,58). If there is no thrombosis, the aneurysm will appear as a flow void on T2WI, occupying the sellar region ( Figure 11C) and may demonstrate homogeneous filling of the aneurysm with contrast on MR angiography ( Figure 11D).…”

Section: Sellar Aneurysmmentioning

confidence: 99%

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Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Goyal¹,

Utz²,

Gupta³

et al. 2018

Quant. Imaging Med. Surg.

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To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism. Pre-existing macro adenoma (65-90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy, which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or microadenoma. Because of the probable grave prognosis of PA, imaging characteristics of PA and other acute clinical scenarios with similar clinical and/or imaging findings should be familiar to radiologists. PA is potentially a life-threatening clinical syndrome, however, imaging and clinical findings can lead the radiologist towards appropriate diagnosis, and rule out other clinical mimics. When hemorrhage is secondary to an underlying lesion, regrowth of the pituitary tumor years after a PA episode is possible and patients require long-term clinical and imaging surveillance.

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Section: Sellar Aneurysmmentioning

confidence: 99%

Section: Sellar Aneurysmmentioning

confidence: 99%

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Goyal¹,

Utz²,

Gupta³

et al. 2018

Quant. Imaging Med. Surg.

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show abstract

“…According to this classification, invasion is "very likely" if the tumor extends laterally and passes a line drawn between the centers of the crosssection of the supra-and intracavernous segments of the internal carotid artery. But it is interesting to note that Xu [11] found sensitivity in only 47% of Knosp assessments in surgical practice with Cushing's disease. In fact, if Knosp landmarks are useful for classifying pituitary macroadenomas and are largely used in the literature but their practical interest is less when differentiating true invasion from compression, and especially for limited invasion of the cavernous sinus located in its back.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging Assessment of Aggressive Pituitary Adenomas

Yusupovna

Talatovna

2021

JPRI

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Aggressive pituitary adenomas (APA) are adenomas that show rapid growth, invasiveness, frequent or multiple relapses, or are resistant to conventional therapies. Clinical-imaging assessment of aggressive pituitary adenomas with the aid of magnetic resonance imaging (MRI) plays an important role in early prediction, further disease outcomes and aggressive behavior of adenomas. Purpose of the Study: was to assess the correlation of neuroimaging data with the hormonal activity of APA. Materials and Methods: The study included 74 patients with aggressive pituitary adenomas. The average age of the patients was from 12 to 69. The patients underwent a basal assessment of the level of pituitary hormones: prolactin (PRL), GH (growth hormone), insulin-like growth factor-1 (IGF-1) and blood cortisol by the RIA method, as well as an MRI study. Knop's classification was used to assess the invasion. Results: The hormonal workup showed prevalence of inactive pituitary adenomas among aggressive adenomas. No correlation was found between the hormonal activity of aggressive adenomas and the volume of pituitary adenomas. Moreover, MRI data indicated that invasion into the cavernous sinus of the III degree and heterogeneity of the adenoma may be considered equivalents of aggressiveness. Conclusion: The established patterns support the need for visualization assessment of aggressive pituitary adenomas and strongly suggest the evaluation of the degree of aggression based on tumor heterogenecity, chiasm compression, hypo- and iso-intensity in T1 mode and hyperintensity in T2 modes.

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“…However, a small number of patients may have extremely rare clinical or imaging manifestations, leading to a difficulty in determining the diagnosis or even misdiagnosis. Due to atypical clinical or imaging manifestations, ruptured intracranial aneurysms have been reported to be misdiagnosed as meningitis, tumors, stroke, or trauma, among other conditions[ 1 - 3 ]. Here, we report what appears to be the first case of a ruptured intracranial aneurysm presenting as cerebral circulation insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report

Zhao¹,

Zhao²,

Tang³

2021

WJCC

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BACKGROUND Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health. Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous consequences in some patients. To date, ruptured intracranial aneurysms have been misdiagnosed as meningitis, tumors, stroke, or trauma, among other conditions. Here, we report what appears to be the first case of a ruptured intracranial aneurysm that presented as cerebral circulation insufficiency. CASE SUMMARY A middle-aged man was admitted to our hospital because of a parasellar lesion identified on a noncontrast computed tomography (CT) image after a mild traffic accident that was caused by a brief loss of consciousness. Notably, he was diagnosed with cerebral circulation insufficiency after two unexplained episodes of a transient loss of consciousness within the past 8 mo. The patient was diagnosed with right internal carotid artery aneurysm based on CT angiography and completely recovered after a craniotomy at our hospital. A few clots and severe adhesions around the aneurysm were observed in the subarachnoid space during the operation, suggesting that the aneurysm had ruptured and may had been misdiagnosed as cerebral circulation insufficiency. CONCLUSION Ruptured intracranial aneurysms may show negative imaging results and present as cerebral circulation insufficiency, which should be recognized as soon as possible to ensure timely management.

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Pituitary adenoma apoplexy caused by rupture of an anterior communicating artery aneurysm: case report and literature review

Cited by 18 publications

References 15 publications

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Neuroimaging Assessment of Aggressive Pituitary Adenomas

Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report

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