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01-11-2008 | Short Illustrated Review

Cerebral ischaemia in pituitary apoplexy

Authors: Shahzada K. Ahmed, Patrick L. Semple

Published in: Acta Neurochirurgica | Issue 11/2008

Abstract

Pituitary apoplexy is a potentially fatal condition that can have serious consequences even after successful treatment. One of the potential complications of this syndrome is occlusion of the internal carotid arteries, which causes cerebral ischaemia. This can occur through one of two mechanisms—direct compression of the artery or vasospasm caused by factors released from haemorrhagic or necrotic material. We illustrate two examples of cerebral ischaemia with pituitary apoplexy, one with compression and one with vasospasm, both ending in a successful resolution. In both, magnetic resonance imaging, angiography, and hormonal studies allow diagnosis, and urgent surgical decompression should be the treatment of choice. We review the literature and discuss the mechanisms.

Akutsu H, Noguchi S, Tsunoda T, Sasaki M, Matsumura A (2004) Cerebral infarction following pituitary apoplexy—case report. Neurologia Medico-Chirurgica 44:479–483PubMedCrossRef

Alewijnse AE, Peters SL, Michel MC (2004) Cardiovascular effects of sphingosine-1-phosphate and other sphingomyelin metabolites. Br J Pharmacol 143:666–684PubMedCrossRef

Bernstein M, Hegele RA, Gentili F, Brothers M, Holgate R, Sturtridge WC et al (1984) Pituitary apoplexy associated with a triple bolus test. Case report. J Neurosurg 61:586–590PubMed

Brougham M, Heusner AP, Adams RD (1950) Acute degenerative changes in adenomas of the pituitary body—with special reference to pituitary apoplexy. J Neurosurg 7:421–439PubMedCrossRef

Cardoso ER, Peterson EW (1983) Pituitary apoplexy and vasospasm. Surg Neurol 20:391–395PubMedCrossRef

Epstein S, Pimstone BL, De Villiers JC, Jackson WP (1971) Pituitary apoplexy in five patients with pituitary tumours. Br Med J 2:267–270PubMed

Itoyama Y, Goto S, Miura M, Kuratsu J, Ushio Y, Matsumoto T (1990) Intracranial arterial vasospasm associated with pituitary apoplexy after head trauma—case report. Neurologia Medico-Chirurgica 30:350–353PubMedCrossRef

Lange M, Pagotto U, Renner U, Arzberger T, Oeckler R, Stalla GK (2002) The role of endothelins in the regulation of pituitary function. Exp Clin Endocrinol Diabetes 110:103–112PubMedCrossRef

Lath R, Rajshekhar V (2001) Massive cerebral infarction as a feature of pituitary apoplexy. Neurology India 49(2):191–193PubMed

10.

List CF, Williams JR, Balyeart GW (1952) Vascular lesions in pituitary adenomas. J Neurosurg 9:177–187PubMed

11.

Macdonald RL, Pluta RM, Zhang JH (2007) Cerebral vasospasm after subarachnoid haemorrhage: the emerging revolution. Nat Clin Pract Neurol 3:256–263PubMedCrossRef

12.

Pozzati E, Frank G, Nasi MT, Giuliani G (1987) Pituitary apoplexy, bilateral carotid vasospasm, and cerebral infarction in a 15-year-old boy. Neurosurgery 20:56–59PubMedCrossRef

13.

Rodier G, Mootien Y, Battaglia F, Martinet O, Cohen E (2003) Bilateral stroke secondary to pituitary apoplexy [4]. J Neurol 250(4):494–495PubMedCrossRef

14.

Rosenbaum TJ, Houser OW, Laws ER (1977) Pituitary apoplexy producing internal carotid artery occlusion. Case report. J Neurosurg 47:599–604PubMed

15.

Rothoerl RD, Ringel F (2007) Molecular mechanisms of cerebral vasospasm following aneurysmal SAH. Neurol Res 29:636–642PubMedCrossRef

16.

Schnitker MT, Lehnert HB (1952) Apoplexy in a pituitary chromophobe adenoma producing the syndrome of middle cerebral artery thrombosis; case report. J Neurosurg 9:210–213PubMed

17.

Semple PL, De Villiers JC, Bowen RM, Lopes MB, Laws ER Jr. (2006) Pituitary apoplexy: do histological features influence the clinical presentation and outcome? J Neurosurg 104:931–937PubMedCrossRef

18.

Semple PL, Webb MK, de Villiers JC, Laws ER Jr. (2005) Pituitary apoplexy. Neurosurgery 56:65–72, discussion 72–63PubMed

19.

Wilson JL, Field JR (1974) Production of intracranial vascular spasm by hypothalamic extract. J Neurosurg 40:473–479PubMed

20.

Xu RK, Wu XM, Di AK, Xu JN, Pang CS, Pang SF (2000) Pituitary prolactin-secreting tumour formation: recent developments. Biol Signals Recept 9:1–20PubMedCrossRef

21.

Yaghmai R, Olan WJ, O’Malley S, Bank WO (1996) Non-haemorrhagic pituitary macroadenoma producing reversible internal carotid artery occlusion: case report. Neurosurgery 38(6):1245–1248PubMedCrossRef

Title: Cerebral ischaemia in pituitary apoplexy
Authors: Shahzada K. Ahmed
Patrick L. Semple
Publication date: 01-11-2008
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2008
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-008-0130-3

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Cerebral ischaemia in pituitary apoplexy

Abstract

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