Bilateral antererior circulation stroke: A rare but threatening consequence of pituitary apoplexy. Case report and systematic literature review.
MRI
anterior cerebral circulation
brain stroke
cerebral infarction
pituitary adenoma
pituitary apoplexy
Journal
The neuroradiology journal
ISSN: 2385-1996
Titre abrégé: Neuroradiol J
Pays: United States
ID NLM: 101295103
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
medline:
15
11
2023
pubmed:
29
3
2022
entrez:
28
3
2022
Statut:
ppublish
Résumé
Brain stroke is a rare, life-threatening condition associated with pituitary apoplexy (PA), resulting from direct arterial occlusion due to mechanical compression secondary to the sudden enlargement of the pituitary adenoma, or to vessel vasospasm, induced by tumor hemorrhage. We report the case of a 64-year-old woman with PA complicated by bilateral anterior circulation stroke due to critical stenosis of both anterior cerebral arteries (ACA). Despite the quick surgical decompression and consequent blood flow restoration, the neurological conditions of the patient did not improve and she died 18 days later. Ten other cases of anterior circulation stroke due to PA were retrieved in a systematic review of literature. Clinical and neuroradiological features of these patients and treatment outcome were assessed to suggest the most proper management. The onset of neurological symptoms suggestive for brain stroke in patients with PA requires performing an emergency Magnetic Resonance Imaging (MRI), including Diffusion-weighted and angiographic MR-sequences. The role of surgery in these cases is debated, however, transsphenoidal adenomectomy would permit us to decompress the ACA and restore blood flow in their territories. Although the prognosis of PA-induced anterior circulation stroke is generally poor, a timely diagnosis and treatment would be paramount for improving patient outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Brain stroke is a rare, life-threatening condition associated with pituitary apoplexy (PA), resulting from direct arterial occlusion due to mechanical compression secondary to the sudden enlargement of the pituitary adenoma, or to vessel vasospasm, induced by tumor hemorrhage.
CASE REPORT
METHODS
We report the case of a 64-year-old woman with PA complicated by bilateral anterior circulation stroke due to critical stenosis of both anterior cerebral arteries (ACA). Despite the quick surgical decompression and consequent blood flow restoration, the neurological conditions of the patient did not improve and she died 18 days later. Ten other cases of anterior circulation stroke due to PA were retrieved in a systematic review of literature. Clinical and neuroradiological features of these patients and treatment outcome were assessed to suggest the most proper management.
CONCLUSION
CONCLUSIONS
The onset of neurological symptoms suggestive for brain stroke in patients with PA requires performing an emergency Magnetic Resonance Imaging (MRI), including Diffusion-weighted and angiographic MR-sequences. The role of surgery in these cases is debated, however, transsphenoidal adenomectomy would permit us to decompress the ACA and restore blood flow in their territories. Although the prognosis of PA-induced anterior circulation stroke is generally poor, a timely diagnosis and treatment would be paramount for improving patient outcome.
Identifiants
pubmed: 35343284
doi: 10.1177/19714009221083146
pmc: PMC10649528
doi:
Types de publication
Systematic Review
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
746-751Déclaration de conflit d'intérêts
Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
Neurosurgery. 1987 Jan;20(1):56-9
pubmed: 3808276
World Neurosurg. 2020 Sep;141:73-80
pubmed: 32522640
JAMA Neurol. 2014 Feb;71(2):226-7
pubmed: 24366004
Skull Base. 2010 Jul;20(4):285-8
pubmed: 21311623
Australas Radiol. 2005 Apr;49(2):127-31
pubmed: 15845049
Neurol Med Chir (Tokyo). 2004 Sep;44(9):479-83
pubmed: 15600283
Eur Neurol. 2020;83(2):121-130
pubmed: 32544913
Clin Endocrinol (Oxf). 2014 Mar;80(3):419-24
pubmed: 23909507
Acta Neurochir (Wien). 2008 Nov;150(11):1193-6; discussion 1196
pubmed: 18958393
Pituitary. 2015 Jun;18(3):352-8
pubmed: 24965694
Turk Neurosurg. 2014;24(5):782-7
pubmed: 25269055
Endocr Connect. 2016 Sep;5(5):G12-G15
pubmed: 27935817
Neuroradiol J. 2010 Jun;23(3):321-4
pubmed: 24148592
World Neurosurg. 2017 Oct;106:331-338
pubmed: 28669873
J Clin Neurosci. 2015 Oct;22(10):1550-4
pubmed: 26213287
Am J Case Rep. 2016 Oct 06;17:707-711
pubmed: 27708253
J Neurol. 2003 Apr;250(4):494-5
pubmed: 12760385
World Neurosurg. 2014 Nov;82(5):781-90
pubmed: 24915069