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Case Reports
. 2008 Dec;23(6):1113-7.
doi: 10.3346/jkms.2008.23.6.1113. Epub 2008 Dec 23.

Pituitary apoplexy producing internal carotid artery compression: a case report

Seung-Ho Yang  1 , Kwan-Sung Lee, Kyo-Young Lee, Sang Won Lee, Yong-Kil Hong
Affiliations
Case Reports

Pituitary apoplexy producing internal carotid artery compression: a case report

Seung-Ho Yang et al. J Korean Med Sci. 2008 Dec.

Abstract

We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV(+) within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.

Keywords: Cerebral Infarction; Cerebrovascular Disorders; Paresis; Pituitary Apoplexy.

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Figures

Fig. 1
Fig. 1
Computed tomography scan (A) showing a heterogeneous mass of high density in the right side. Coronal magnetic resonance (MR) image showing heterogeneous high-signal intensity on the T2-weighted image (B), slightly elevated signal intensity on the T1-weighted image (C) and focal enhancement with gadolinium (D), suggesting a necrotic or hemorrhagic site.
Fig. 2
Fig. 2
Non-visualization of the right internal carotid artery on MRA (A) and linear high signal intensity in the right fronto-parietal region on a diffusion-weighted image (B).
Fig. 3
Fig. 3
Microscopic examination showing the infarct region in which viable cells are seen only around the vascular channels (H&E, ×100 [A] and ×200 [B]).
Fig. 4
Fig. 4
Anteroposterior (A) and lateral view (B) of a conventional angiography performed one week after the operation, and MRA (C) showing the restoration of cerebral blood flow.
See this image and copyright information in PMC

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