Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review

Abstract

Background: Pituitary tumor apoplexy (PTA) is a potentially fatal condition caused by hemorrhage and rapid expansion of a pituitary tumor. One rare consequence of PTA is occlusion of the intracavernous carotid arteries, very rarely leading to cerebral infarction.

Purpose: To describe a case of PTA leading to bilateral cerebral infarction and provide an extensive literature review of all previously reported cases of PTA leading to cerebral infarction. We discuss how these cases contribute to our understanding of the management of PTA, and we also discuss the differences between cases associated with the reported mechanism of carotid occlusion (compression vs. vasospasm).

Case presentation: A 56-year-old previously healthy woman complained of severe headache and visual loss one day after sustaining a fall from standing. Computed tomography demonstrated an enlarged sellar and suprasellar mass displacing both cavernous ICAs laterally, with multiple bilateral hypodense areas in the ICA distribution consistent with infarction. She clinically deteriorated and underwent endoscopic transsphenoidal gross total resection for suspected PTA within 48 hours after falling. Her prognosis remained poor after 5 days, and support was withdrawn.

Conclusion: Twenty-four cases of PTA leading to cerebral infarction have been previously documented-four bilateral, our case being the fifth. Based on our review, the presence of infarction itself does not seem to warrant surgical management in the absence of previously established indications for surgery (such as a deteriorating visual field), despite a 3-5 times mortality increase. No conclusion regarding the role of the mechanism of occlusion can be made at this time.