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Case Reports
. 2013 Mar 28:4:41.
doi: 10.4103/2152-7806.109654. Print 2013.

Chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy

Masato Hojo  1 , Masanori Goto, Susumu Miyamoto
Affiliations
Case Reports

Chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy

Masato Hojo et al. Surg Neurol Int. .

Abstract

Background: Enlargement of intracerebral hematoma without rebleeding in chronic phase is a rare but well-known clinical condition, and is well-described as chronic expanding intracerebral hematoma. However, chronic enlargement of pituitary hematoma without rebleeding after pituitary apoplexy is extremely rare.

Case description: We report a case of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy. A 29-year-old male presented with sudden onset of headache and vomiting. Magnetic resonance imaging (MRI) demonstrated a pituitary mass lesion with hematoma, consistent with pituitary apoplexy. Neuro-ophthalmological examination revealed no visual field defect, and endocrinological evaluations showed an elevated prolactin level. Pituitary apoplexy due to a prolactinoma was the most likely diagnosis. He was conservatively treated because he exhibited no visual disturbance. Three weeks after the onset, he gradually began to complain of blurred vision and neuro-ophthalamological examination revealed bitemporal upper quadrant hemianopsia. MRI showed enlargement of the pituitary hematoma without any finding suggestive of rebleeding. This enlarged mass lesion compressed the chiasm. The patient was operated on via transsphenoidal approach. After dural opening, xanthochromic fluid spouted out, but no fresh clot could be detected within the cyst. After the operation, the visual field disturbance resolved completely. The possible mechanism of hematoma enlargement is considered to be expansion due to the serum exudation from capillaries of the hematoma capsule. This pathogenetic mechanism is common in enlargement of chronic subdural hematoma.

Conclusions: This case is the first report of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.

Keywords: Chronic expanding hematoma; pituitary adenoma; pituitary apoplexy; prolactinoma; transsphenoidal surgery.

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Figures

Figure 1
Figure 1
MR images obtained 2 weeks (a, b) and 3 weeks (c) after onset, (a) coronal T1-weighted image demonstrated intra-and suprasellar mass with a central area of high signal intensity consistent with hematoma of subacute phase. The hyperintense signal may correspond to hemoglobin degradation content as extracellular methhemoglobin, (b) sagittal postgadolinium T1-weighted image showed rim enhancement of hematoma capsule, (c) coronal T1-weighted image demonstrated enlargement of pituitary hematoma resulting in compression of the chiasm (arrows). No sign of rebleeding was detected. Compared with MR images obtained 2 weeks after onset (a), the compression of chiasm was markedly worsened for this one week (c, arrows)
Figure 2
Figure 2
Intraoperative microphotograph showing the content of hematoma. Xanthochromic fluid was spouted after dural opening (arrows)
See this image and copyright information in PMC

References

    1. Aoki N, Mizuguchi K. Chronic encapsulated intracerebellar hematoma in infancy: Case report. Neurosurgery. 1984;14:594–7. - PubMed
    1. Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, et al. Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: A prospective study. J Neurosurg. 2004;100:24–32. - PubMed
    1. Fujisawa H, Nomura S, Kajiwara K, Kato S, Fujii M, Suzuki M. Various magnetic resonance imaging patterns of chronic subdural hematomas: Indicators of the pathogenesis? Neurol Med Chir. 2006;46:333–8. - PubMed
    1. Hirsh LF, Spector HB, Bogdanoff BM. Chronic encapsulated intracerebral hematoma. Neurosurgery. 1981;9:169–72. - PubMed
    1. Liu ZH, Chang CN, Pai PC, Wei KC, Jung SM, Chen NY, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. 2010;17:694–9. - PubMed

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