Republished: Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment

Abstract

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

“…In conclusion, this case suggests that an internal carotid cavernous segment aneurysm can present with bilateral painful ophthalmoplegia. Given the potentially fatal outcome of aneurysmal rupture [ 13 ], any patient who presents with bilateral painful ophthalmoplegia should be promptly screened using CTA or MRA.…”

Simultaneous Aneurysmal Subarachnoid Hemorrhage and Epistaxis in an Untreated Prolactinoma: A Case Report and Literature Review

“…Table 1 summarizes the details of this case and seven other similar cases. [7][8][9][11][12][13][14] The cases are listed in order according to the publication year. All the pituitary tumors in the present review were prolactinomas, which caused an intracranial hemorrhage in six of eight cases.…”

“…In the case of giant prolactinomas, some opinions suggest that priority should be given to cabergoline treatment for tumor reduction and normalization of PRL level due to their high invasiveness and the fragility of the aneurysm wall. 10 ) However, three cases of tumor shrinkage and aneurysm rupture following cabergoline treatment have previously been reported, 7 - 9 ) suggesting that we should be aware of the possibility of aneurysm coexistence. In the presence of coexisting aneurysms, aneurysm treatment should be prioritized.…”

“…Several cases of cerebrospinal fluid (CSF) rhinorrhea or aneurysm rupture caused by the rapid shrinkage of adenoma following medication administration has been reported. [6][7][8][9] However, no cases of SAH and epistaxis in completely untreated prolactinomas have been reported. In this report, we present a rare case of a ruptured ICAPA with simultaneous occurrence of SAH and massive epistaxis in an untreated prolactinoma.…”