Interdisciplinary Neurosurgery (Sep 2023)

Stroke due to extrinsic compression of the internal carotide secondary to invasive hypophyseal macroadenoma with pituitary Apoplejia: A case report and literature review

  • Jorge Wilmar Tejada-Marin, M.D.,
  • Guillermo Edinson Guzmán-Gómez, M.D.,
  • Andrés Octavio García-Trujillo, M.D.,
  • Fabio Nelson Figueroa-Agudelo, M.D.,
  • Juan Camilo Márquez, M.D.,
  • Andrés Felipe Peña-Arciniegas,
  • Juan Esteban Aponte-Arroyo,
  • Maria Angélica Guerra, M.D.

Journal volume & issue
Vol. 33
p. 101797

Abstract

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Background: Pituitary apoplexy is a medical emergency with a low population incidence that is more frequent in patients with pituitary tumors and whose management is mainly surgical. We present a description of a patient with ischemic cerebrovascular disease (CVD) secondary to extrinsic compression of the internal carotid artery by a pituitary macroadenoma presenting pituitary apoplexy.Case presentation: We present the case of a 43-year-old female patient with type diabetes mellitus and with invasive pituitary macroadenoma with extrinsic compression of the internal carotid artery, she consulted the emergency room for generalized tonic-clonic seizures, drowsiness, left hemiplegia and neurological deterioration for which she needed management in the ICU, with brain MRI showing sellar and suprasellar lesion invading the cavernous sinus and right Meckel's cavum, a mass surrounds the right internal carotid artery in its cavernous and supraclinoid segments, and decrease in the caliber of the proximal segments of the ipsilateral middle cerebral and anterior cerebral arteries, longitudinal axis 37 mm, with hemoglobin degradation residues suggestive of pituitary apoplexy. In addition, central hypothyroidism without other alterations. She was not a candidate for surgical management due to an infectious process (sinusitis), initiating management with cabergoline with clinical improvement, greater interaction with the environment. MRI at one month showed significant reduction of the lesion (25x23x26mm). Conclusion: Ischemic CVD due to extrinsic compression of the middle cerebral artery by hypophyseal apoplexy is infrequent, only 33 similar cases have been reported worldwide that have been taken to surgery; this is a successful case of treatment with medical management due to the impossibility of surgical management.

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