Double jeopardy - pituitary apoplexy complicated by ruptured aneurysm of the internal carotid artery within an adenoma: a case report
1
Issued Date
2022-12-01
Resource Type
eISSN
14712377
Scopus ID
2-s2.0-85143668014
Pubmed ID
36494782
Journal Title
BMC Neurology
Volume
22
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Neurology Vol.22 No.1 (2022)
Suggested Citation
Pattaravimonporn N., Muninthorn W., Sudsang T., Hansasuta A., Chiewchalermsri D., Sriphrapradang C. Double jeopardy - pituitary apoplexy complicated by ruptured aneurysm of the internal carotid artery within an adenoma: a case report. BMC Neurology Vol.22 No.1 (2022). doi:10.1186/s12883-022-02999-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85201
Title
Double jeopardy - pituitary apoplexy complicated by ruptured aneurysm of the internal carotid artery within an adenoma: a case report
Author's Affiliation
Other Contributor(s)
Abstract
Background: Sudden onset of severe headache is the most common presentation of a ruptured intracranial aneurysm. Similar symptoms can be caused by pituitary apoplexy, and radiological examination is needed to distinguish between the two. Development of infarction and/or haemorrhage of the hypophysis with concomitant unruptured cerebral aneurysm has been described. However, intratumoural aneurysm within a pituitary adenoma presenting with the ictus of both pathologies is extremely rare. Case presentation: A 64-year-old man presented with classic symptoms of pituitary apoplexy. His symptoms improved after a few days, and he was discharged. However, he subsequently developed further episodes of sudden and severe headache together with visual decline and ophthalmoplegia. Radiographs demonstrated an enlarging sellar mass with suspicion of a ruptured internal carotid artery aneurysm, within the apoplectic pituitary macroadenoma. Although an endovascular procedure was planned, the patient developed massive subarachnoid haemorrhage resulting in brain death. Conclusion: This case report describes an intratumoural aneurysm of the cavernous internal carotid artery as a potential cause or result of pituitary apoplexy. Despite its rarity, this possible life-threatening complication of pituitary apoplexy should be recognised for prompt diagnosis and early management.