Unusual bifrontal cerebral infarction related to pituitary apoplexy. An uncommon presentation and literature review

Surg Neurol Int. 2022 Dec 9:13:577. doi: 10.25259/SNI_979_2022. eCollection 2022.

Abstract

Background: Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms are headache, visual impairment, ophthalmoplegia, and hypopituitarism. The relationship between stroke and PA is uncommon and two mechanisms are described: vascular compression and vasospasm.

Case report: A 65-old-year man presented with severe headache, vomiting, ophthalmoplegia, and somnolence. Radiological examinations showed an expansive sellar and suprasellar lesion with a heterogeneous signal, besides Diffusion-weighted imaging (DWI) restriction in the bifrontal area was present. The findings were compatible with PA and stroke.

Conclusion: PA leading to cerebral infarction is a rare condition that presents high morbidity and mortality levels. There are two main mechanisms related: direct arterial compression and arterial vasospasm. The cases must be conducted as neuroendocrinological emergencies and surgical management is a key point to better the prognosis of patients.

Keywords: Anterior cerebral artery; Neuroendoscopy; Pituitary apoplexy; Skull base; Stroke.

Publication types

  • Case Reports