Q J Med 2015; 108:159 doi:10.1093/qjmed/hcu153
Advance Access Publication 30 July 2014
Clinical picture Carotid artery compression from pituitary apoplexy Description of Image
Photographs and text from: G. Asaithambi, Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610, USA. email: [email protected] Conflict of interest: None declared.
References 1. Ahmed SK, Semple PL. Cerebral ischaemia in pituitary apoplexy. Acta Neurochir (Wien) 2008; 150:1193–6. 2. Rebeiz T, Cueva W, Ardelt A. Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol 2014; 71:226–7.
Figure 1. FLAIR sequence of MRI brain (A) that demonstrates a large pituitary adenoma (arrow). There is evidence of stenosis of the bilateral paraclinoid segments of the internal carotid arteries as seen on MRA brain (B).
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 17, 2015
A 54-year-old previously healthy man presented after a fall from a ladder with progressive vision loss and headache. Physical examination revealed poor visual acuity in both eyes with the ability to only differentiate between light and dark and partial third, fourth and sixth nerve palsies of the right eye. Magnetic resonance imaging of the brain was performed and revealed a 4.7 3 3 cm pituitary adenoma (Figure 1A). He underwent transsphenoidal resection of this mass and was confirmed to have pituitary tumor apoplexy after resection. Post-operatively his visual acuity improved to 20/20 in the right eye and 20/ 60 in the left eye; he had bitemporal hemianopsia and was left with a right partial third nerve palsy. While not clinically evident, the tumor was found to be compressing the paraclinoid segments of both internal carotid arteries and resulted in 70%– 80% stenosis bilaterally (Figure 1B). Mechanical
compression of intracranial arteries by an expanding sellar mass has been rarely reported and can result in cerebral ischemia.1,2 Noninvasive vascular imaging should be considered for such large sellar tumors to assess the risk for cerebrovascular complications.
Advance Access Publication 30 July 2014
Clinical picture Carotid artery compression from pituitary apoplexy Description of Image
Photographs and text from: G. Asaithambi, Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610, USA. email: [email protected] Conflict of interest: None declared.
References 1. Ahmed SK, Semple PL. Cerebral ischaemia in pituitary apoplexy. Acta Neurochir (Wien) 2008; 150:1193–6. 2. Rebeiz T, Cueva W, Ardelt A. Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol 2014; 71:226–7.
Figure 1. FLAIR sequence of MRI brain (A) that demonstrates a large pituitary adenoma (arrow). There is evidence of stenosis of the bilateral paraclinoid segments of the internal carotid arteries as seen on MRA brain (B).
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 17, 2015
A 54-year-old previously healthy man presented after a fall from a ladder with progressive vision loss and headache. Physical examination revealed poor visual acuity in both eyes with the ability to only differentiate between light and dark and partial third, fourth and sixth nerve palsies of the right eye. Magnetic resonance imaging of the brain was performed and revealed a 4.7 3 3 cm pituitary adenoma (Figure 1A). He underwent transsphenoidal resection of this mass and was confirmed to have pituitary tumor apoplexy after resection. Post-operatively his visual acuity improved to 20/20 in the right eye and 20/ 60 in the left eye; he had bitemporal hemianopsia and was left with a right partial third nerve palsy. While not clinically evident, the tumor was found to be compressing the paraclinoid segments of both internal carotid arteries and resulted in 70%– 80% stenosis bilaterally (Figure 1B). Mechanical
compression of intracranial arteries by an expanding sellar mass has been rarely reported and can result in cerebral ischemia.1,2 Noninvasive vascular imaging should be considered for such large sellar tumors to assess the risk for cerebrovascular complications.
