Pituitary Apoplexy Complicated by Chemical Meningitis and Cerebral Infarction

Abstract

A 41-yr-old man was admitted with acute headache, neck stiffness, and febrile sensation. Cerebrospinal fluid examination showed pleocytosis, an increased protein level and, a decreased glucose concentration. No organisms were observed on a culture study. An imaging study revealed pituitary macroadenoma with hemorrhage. On the 7th day of the attack, confusion, dysarthria, and right-sided facial paralysis and hemiparesis were noted. Cerebral infarction on the left basal ganglia was confirmed. Neurologic deficits gradually improved after removal of the tumor by endoscopic transnasal transsphenoidal approach. It is likely that the pituitary apoplexy, aseptic chemical meningitis, and cerebral infarction are associated with each other. This rare case can serve as a prime example to clarify the chemical characteristics of pituitary apoplexy.

Surgical treatment of pituitary apoplexy in association with hemispheric infarction

“…Cerebral vasospasm could be another mechanism of cerebral infarction in these patients [5,17,[26][27][28][29][30][31][32][33][34]. Cerebral vasospasm is attributed to SAH [27,29,30,33,34] and the release of vasoactive substances from the hemorrhagic or necrotic pituitary adenoma [5,17,28,[31][32][33] or damaged hypothalamus [17].…”

Pituitary Apoplexy: A MRI Finding Case and Literature Review

“…They are present in 76% of cases and can mimic the pain observed in meningeal irritations [8]. Anomalies of vision were found in 62% of cases [9] [10]. This decrease in visual acuity and alteration of the visual field are due to the expansion of the tumor with compression of the chiasma and/or optic nerves.…”

“…CT scan and MRI can easily be used to confirm this diagnosis, but cranio-encephalic MRI is the best reference for the diagnosis of the pituitary ade-E. V. Acko-Ohui et al Open Journal of Radiology noma and the pituitary apoplexy complication [9]. MRI allows visualizing the tumor and assessing its extension.…”

Acute Ischaemic Stroke as a Manifestation of Pituitary Apoplexy in a Young Lady

“…The ICA was occluded in the cavernous sinus or supraclinoid portion by the enlarged tumour in most cases [9]. The pathophysiology of vasospasm could be the release of vasoactive substances from the necrotic haemorrhagic tumour itself [8,10], hypothalamic dysfunction, intra-operative manipulation, direct arterial wall injury and the subarachnoid blood [11]. In our case the compression of cavernous portion of left ICA is the mechanism of ischaemic stroke.…”

“…There are only a few cases reporting mechanical compression of circle of willis as the chief event of cerebral ischaemic as illustrated by Rosenbaum TJ et al,Lath R and Rajshekar V et al,[12,13], and few other studies [7,9,14], while a few reporting cerebral vasospasm as the primary event [10,11,[15][16][17][18]. Following [ Table/ 3a 3b 3c [ -4]: Reviews the published studies on association of acute ischaemic stroke following pituitary apoplexy.…”