Serious Complication of Pituitary Apoplexy

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CY Cheung, B Lo, PP Iu

Hong Kong J Radiol 2009;12:64-7

A 50-year-old man suddenly collapsed at home following an acute episode of severe headache. At admission, his consciousness level was 4/15 on the Glasgow Coma Scale. Urgent computed tomography of the brain showed a large enhancing suprasellar mass. Follow-up computed tomography scan showed massive bifrontal and left inferior basal ganglion infarctions. Magnetic resonance imaging of the brain and pituitary gland confirmed the diagnosis of pituitary apoplexy and infarctions. The mass effect from the infarctions was not controlled by external drainage catheter alone and decompressive bifrontal craniectomy was required. Trans-sphenoidal debulking of the pituitary tumour was performed. The patient survived, but had severe disability. The mechanisms of cerebral infarct associated with pituitary apoplexy and the possible treatments are discussed.