Unusual Case of Bilateral Caudate Infarcts Following Pituitary Apoplexy

Abstract

ituitary apoplexy can be a fatal condition. It rarely causes cerebral ischemia through compression or vasospasm. We report a case of pituitary apoplexy causing compression of bilateral anterior cerebral arteries and leading to bilateral caudate infarcts. Report of a Case An 81-year-old woman known to have hypertension and a pituitary macroadenoma compressing the prechiasmatic optic nerves and causing significant bilateral blindness presented with stupor and generalized weakness. On the day of presentation, she had significant weakness and was not able to stand. She was brought to the emergency department and was found to be stuporous, hypotensive, and in shock, with the lowest recorded systolic blood pressure of 76 mm Hg. She was subsequently resuscitated with intravenous fluids, supported with 4 intravenous pressors, and endotracheally intubated. Neurological examination revealed a stuporous woman, not opening her eyes or following commands but with intact brainstem reflexes. She had an asymmetric quadriparesis with left hemibody weakness greater than right, left-sided spasticity and hyperreflexia, and upturning toes bilaterally. Brain magnetic resonance imaging showed a sella-based mass with intrinsic hemorrhage (Figure, A) and infarcts in the anterior cerebral ar

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

“…Fig-4] reviews the published studies on association of acute ischaemic stroke following PA. Bilateral caudate nuclear infarcts secondary to PA was also described recently by Rebeiz T et al, [18].…”

“…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.…”

Surgical treatment of pituitary apoplexy in association with hemispheric infarction

“…The overlap between spasm and extrinsic compression did not permit a clear differentiation of these two mechanisms in some situations, as angiography and/or MRA was not always performed. Hypotension superimposed upon mechanical compression [39], cerebral vasospasm [40], and the slow flow caused by ICA bilateral stenosis [35] has been postulated for PA-related watershed cerebral infarction in one patient.…”

Endocrine Emergencies With Neurologic Manifestations

“…1 Cerebral ischemia is a rare complication that can be due to cerebral vasospasm or compression of the cerebral arteries, leading to focal neurologic deficits. 11 Endocrine dysfunction is common and can be present before the apoplexy. Corticotropic deficiency occurs in 50% KEY POINTS h As endocrine emergencies can be successfully managed if accurately and promptly diagnosed, clinical neurologists should be aware of the neurologic manifestations of endocrine emergencies.…”