Cerebral Infarction from Compression of the Internal Carotid Artery - A Rare Presentation of Pituitary Apoplexy

Uppalapati Kali,Ramnarine Narindra,Seetahal-Maraj Panduranga

doi:10.23937/2643-4474/1710080

Abstract

A 42-year-old female presented with sudden onset of headaches, left hemiplegia and bitemporal hemianopia. Radiological investigations revealed right anterior circulation infarction from mechanical obstruction of the right internal carotid artery by Pituitary Apoplexy. She underwent an urgent transsphenoidal decompression of the sella and had gradual resolution of symptoms.

Highlights

Pituitary apoplexy is an uncommon but potentially life-threatening complication of pituitary adenomas
Mechanical compression of the cerebral vasculature and vasospasm are proposed to be the two main mechanisms of infarction. This atypical cause of cerebral ischemia should be considered in any patient with a pituitary adenoma, it should be added to the list of etiologies of cerebrovascular accidents
There is no consensus on the ideal timing of surgery, due to limited case reports in the literature

Summary

Conclusion

PApresenting with cerebral infarction is a rare occurrence, with only sporadic reports in the literature. Mechanical compression of the cerebral vasculature and vasospasm are proposed to be the two main mechanisms of infarction. This atypical cause of cerebral ischemia should be considered in any patient with a pituitary adenoma, it should be added to the list of etiologies of cerebrovascular accidents. There is no consensus on the ideal timing of surgery, due to limited case reports in the literature. Standardised reporting of these cases is recommended to allow detailed analysis which would aid in development of protocols to treat this condition. There were no sources of funding and none of the authors have financial disclosures

Introduction

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Discussion