Surgical treatment of pituitary apoplexy in association with hemispheric infarction

Zou, Zhang‐Yu; Liu, Changyun; Sun, Bin; Chen, Chunmei; Xiong, Wentin; Che, Chun‐Hui; Huang, Huapin

doi:10.1016/j.jocn.2015.03.049

Cited by 15 publications

(21 citation statements)

References 39 publications

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“…PA leading to cerebral infarction is uncommon. Forty-six patients were included in this study [2, 4-44]. A history of pituitary tumour was reported in 8.7% of patients, which is a very small proportion.…”

Section: Discussionmentioning

confidence: 99%

“…There are 2 main pathophysiological mechanisms of the disease: one is the compression of intracranial blood vessels by a tumour and the other is blood vessel spasm caused by tumour bleeding [2]. In 25 patients with cerebral infarction caused by PA, infarction was due to direct intracranial vascular compression [4-6, 10, 14, 19, 21, 23-26, 29, 30, 33-35, 37-39, 41-44].…”

Section: Discussionmentioning

confidence: 99%

“…In general, tumours compress unilateral arteries, but 5 cases of bilateral ICA compression [7, 9, 19, 26, 29] and 3 cases of bilateral ACA compression have been reported in the literature [18, 28, 39]. Cerebral vasospasm is another mechanism of cerebral infarction caused by PA [2, 7, 8, 11-13, 15, 17, 18, 21, 22, 27, 28, 31, 32, 40]. First, pituitary tumour haemorrhage enters the subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

“…Pituitary apoplexy (PA) manifests as acute pituitary infarction or haemorrhage, and the main symptoms are acute headache, impaired vision, and reduced level of consciousness [1, 2]. PA was first reported by Bailey in 1989, and the current incidence is approximately 0.6–22% [1, 3].…”

Section: Introductionmentioning

confidence: 99%

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Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

et al. 2020

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Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

et al. 2020

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“…Cerebral infarction secondary to arterial vasospasm is an extremely rare complication of PA, and only a few cases have been reported 2 3…”

Section: Descriptionmentioning

confidence: 99%

Pituitary apoplexy complicated by vasospasm and bilateral cerebral infarction

et al. 2016

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DESCRIPTIONPituitary apoplexy (PA) is a clinical syndrome caused by acute haemorrhage or infarction of the pituitary gland, generally within a pituitary adenoma, and manifests as visual impairment, severe headache, meningeal irritation, consciousness disturbance and hormonal dysfunction. 1Cerebral infarction secondary to arterial vasospasm is an extremely rare complication of PA, and only a few cases have been reported. A 55-year-old postmenopausal woman was admitted to the emergency department, with worsening headache and decreased visual acuity. An unenhanced CT scan detected a 3 cm pituitary mass without signs of subarachnoid haemorrhage (SAH). Two days later, she developed fever (39.1°C), and a second CT showed a larger hyperdense sellar mass, suggesting intralesional bleeding of a pituitary adenoma with secondary hypothalamus compression. Laboratory analyses revealed increased erythrocyte sedimentation rate (64 mm/hour) and pituitary hypofunction (table 1). The patient became lethargic, and a subsequent brain MRI examination confirmed the presence of a giant haemorrhagic sellar mass (figure 1) with mild meningeal enhancement, indicative of meningeal irritation. A focal cerebral oedema without signs of restriction was also noted in the left mesial temporal region on diffusion-weighted imaging (DWI). Trans-sphenoidal decompression and tumour excision were performed 3 days after the diagnosis of PA. A second MRI scan (completed the same day for difficult post-operative awakening) detected bilateral extensive ischaemic lesions with DWI restriction affecting the territory of the basilar artery (right cerebellum) and middle-anterior cerebral artery (figure 2), and associated with arterial vasospasm (figure 3) without signs of SAH.

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Pituitary Apoplexy Associated with Carotid Compression and a Large Ischemic Penumbra

Sussman

Pendharkar

et al. 2016

World Neurosurgery

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Surgical treatment of pituitary apoplexy in association with hemispheric infarction

Cited by 15 publications

References 39 publications

Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

Pituitary apoplexy complicated by vasospasm and bilateral cerebral infarction

Pituitary Apoplexy Associated with Carotid Compression and a Large Ischemic Penumbra

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