Abstract
IntroductionA ruptured aneurysm associated with a pituitary apoplexy is rare. We present the first case report of the coexistence of a ruptured posterior communicating aneurysm with a surgically discovered pituitary apoplexy where the pituitary apoplexy had not been diagnosed by a pre-operative computerized tomography scan.Case presentationA 31-year-old right-handed Chinese woman began to experience severe headache, vomiting and blurred vision which continued for two days. On admission to the hospital, a brain computerized tomography scan demonstrated a small amount of increased signal in the basal cisterns; no evidence of intrasellar and suprasellar lesions was seen. The appearance of her brain suggested aneurysmal subarachnoid hemorrhage. She had nuchal rigidity and reduced vision. There was no extra-ocular palsy and no other neurological deficit. Our patient had no stigmata of Cushing’s syndrome or acromegaly. During an interview for further history, she reported normal menses and denied reduced vision.Cerebral digital subtraction angiography was subsequently performed, which revealed a 6mm left posterior communicating aneurysm. Urgent left pterional craniotomy was performed. The left ruptured posterior communicating artery aneurysm was completely dissected prior to clipping. At surgery, a suprasellar mass was discovered, the tumor bulging the diaphragma sella and projecting anteriorly under the chiasm raising suspicion of a pituitary tumor. The anterior part of the tumor capsule was opened and a necrotic tumor mixed with dark old blood was removed. The appearance suggested pituitary apoplexy.Histopathology revealed pituitary adenoma with evidence of hemorrhagic necrosis. Our patient made a good recovery.ConclusionOur case report proves that pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm. This association should be considered when evaluating any case of aneurysm. A normal computerized tomography scan does not exclude pituitary apoplexy. Pre-operative magnetic resonance imaging interpretation is required if a pituitary apoplexy is suspected. Craniotomy allows a coexisting aneurysm and pituitary apoplexy to be simultaneously treated.
Highlights
A ruptured aneurysm associated with a pituitary apoplexy is rare
Our case report proves that pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm
Pre-operative magnetic resonance imaging interpretation is required if a pituitary apoplexy is suspected
Summary
Our case proves that a pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm; this association should be considered when evaluating any case of aneurysm. Craniotomy allows a coexisting aneurysm and a pituitary apoplexy to be simultaneously treated. 9. Bulsara KR, Karavadia SS, Powers CJ, Paullus WC: Association between pituitary adenomas and intracranial aneurysms: an illustrative case and review of the literature. Torres A, Dammers R, Krisht AF: Bilateral internal carotid artery aneurysm simulating pituitary apoplexy: case report. Shahlaie K, Olaya JE, Hartman J, Watson JC: Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply. Doi:10.1186/1752-1947-8-166 Cite this article as: Song et al.: Coexistence of aneurysmal subarachnoid hemorrhage and surgically identified pituitary apoplexy: a case report and review of the literature. Authors’ contributions R-XS, D-KW and Z-WW were involved in the initial writing of the manuscript. X-GL provided intellectual contributions to the content of the manuscript as well as editorial assistance. All authors have read and approved the final version of the manuscript
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