Cerebral and Cerebellar Ischaemia in Pituitary Apoplexy: A Case Report

Durmuş N. A., Iddı Kassım M., Ali K.

Neurosurgery Cases and Reviews, cilt.3, sa.1, ss.1-5, 2020 (Hakemli Dergi)

Özet

Abstract

Background: Pituitary apoplexy followed by cerebral ischaemia is very rare and life-threatening clinical syndrome. Ischemia is a rare complication after pituitary apoplexy. Cerebral ischemia due to pituitary apoplexy has been linked to two mechanisms; this can occur through one of two mechanisms-direct compression of the artery or vasospasm caused by vasoactive factors/agents released from haemorrhagic or necrotic material of the pituitary adenoma.

Case description: A 42-year-old male patient with known chronic myeloid leukemia (CML) disease presented to our clinic with vomiting, severe headache which started about 3 days earlier and visual impairment. The cranial MRI with multiplanar and multi sequencies obtained specifically for the pituitary gland Pre-Post gadolinium contrast showed an enlarged sella turcica with large sellar and suprasellar heterogenous mass lesion. Patient underwent transsphenoidal excision of the pituitary tumor. The second day after operation the patient had severe headache and became confused. An emergency cranial CT scan was perfomed and demonstated massive hypodensity areas in the right temporal and frontoparietal lobes, which suggested a decrease in perfusion as well as right side global brain edema and ischemic infarct.

Conclusion: Although, clinicians focus on visual disturbance and endocrine problems in pituitary apoplexy, should be kept in mind that patients may have cerebral infarction in different regions with the effect of vasospasm and we should be aware of this aspect.