Abstract
BACKGROUNDLarge pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion. Here, the authors present a case of pituitary apoplexy causing acute bilateral ICA occlusion with resultant stroke. Our middle-aged patient presented with sudden vision loss and experienced rapid deterioration requiring intubation. Computed tomography (CT) angiography revealed a large pituitary mass causing severe stenosis of the bilateral ICAs. CT perfusion revealed a significant perfusion delay in the anterior circulation. The patient was taken for cerebral angiography, and balloon angioplasty was attempted with no improvement in arterial flow. Resection of the tumor was then performed, with successful restoration of blood flow. Despite restoration of luminal patency, the patient experienced bilateral ICA infarcts.OBSERVATIONSPituitary apoplexy can present as an acute stroke due to flow-limiting carotid compression. Balloon angioplasty is ineffective for the treatment of this type of compression. Surgical removal of the tumor restores the flow and luminal caliber of the ICA.LESSONSPituitary apoplexy can be a rare presentation of acute stroke and should be managed with immediate surgical decompression rather than attempted angioplasty in order to restore blood flow and prevent the development of cerebral ischemia.
Highlights
Large pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion
We describe the first known case of pituitary apoplexy presenting as an acute stroke and being taken urgently to the angiography suite for intervention
She had last been seen in normal condition 5 hours prior. She was initially awake and responding appropriately but progressively became more lethargic, and a noncontrast computed tomography (CT) scan of her head was obtained, which revealed a large, nonhemorrhagic pituitary mass. She was transferred to our facility for neurosurgical evaluation and upon arrival was noted to be unresponsive with a Glasgow Coma Scale score of 5
Summary
Large pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion. LESSONS Pituitary apoplexy can be a rare presentation of acute stroke and should be managed with immediate surgical decompression rather than attempted angioplasty in order to restore blood flow and prevent the development of cerebral ischemia. We describe the first known case of pituitary apoplexy presenting as an acute stroke and being taken urgently to the angiography suite for intervention. Recognizing this presentation would expedite appropriate management, which involves surgical decompression via tumor resection rather than endovascular interventions
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