Coexistence of aneurysmal subarachnoid hemorrhage and surgically identified pituitary apoplexy: a case report and review of the literature

Journal of Medical Case Reports

Xin-Gang Li²  Guang-Xin Wei¹  Shou-Xian Wang¹  Zeng-Wu Wang¹  Zhe Wang¹  Dao-Kui Wang¹  Ren-Xing Song¹ 

[1] Department of Neurosurgery, Weifang People’s Affiliated Hospital, Weifang Medical College, 423 Dongfeng West Street, Weifang 261041, China;Department of Neurosurgery, Qilu Hospital of Shandong University, 107 Wenhua West Street, Jinan 250012, P.R. China

关键词: Subarachnoid hemorrhage;    Pituitary adenoma;    Pituitary apoplexy;    Aneurysm;   

Others  :  1231497
DOI  :  10.1186/1752-1947-8-166

 received in 2013-11-30, accepted in 2014-03-10,  发布年份 2014

【 摘 要 】

Introduction

A ruptured aneurysm associated with a pituitary apoplexy is rare. We present the first case report of the coexistence of a ruptured posterior communicating aneurysm with a surgically discovered pituitary apoplexy where the pituitary apoplexy had not been diagnosed by a pre-operative computerized tomography scan.

Case presentation

A 31-year-old right-handed Chinese woman began to experience severe headache, vomiting and blurred vision which continued for two days. On admission to the hospital, a brain computerized tomography scan demonstrated a small amount of increased signal in the basal cisterns; no evidence of intrasellar and suprasellar lesions was seen. The appearance of her brain suggested aneurysmal subarachnoid hemorrhage. She had nuchal rigidity and reduced vision. There was no extra-ocular palsy and no other neurological deficit. Our patient had no stigmata of Cushing’s syndrome or acromegaly. During an interview for further history, she reported normal menses and denied reduced vision.

Cerebral digital subtraction angiography was subsequently performed, which revealed a 6mm left posterior communicating aneurysm. Urgent left pterional craniotomy was performed. The left ruptured posterior communicating artery aneurysm was completely dissected prior to clipping. At surgery, a suprasellar mass was discovered, the tumor bulging the diaphragma sella and projecting anteriorly under the chiasm raising suspicion of a pituitary tumor. The anterior part of the tumor capsule was opened and a necrotic tumor mixed with dark old blood was removed. The appearance suggested pituitary apoplexy.

Histopathology revealed pituitary adenoma with evidence of hemorrhagic necrosis. Our patient made a good recovery.

Conclusion

Our case report proves that pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm. This association should be considered when evaluating any case of aneurysm. A normal computerized tomography scan does not exclude pituitary apoplexy. Pre-operative magnetic resonance imaging interpretation is required if a pituitary apoplexy is suspected. Craniotomy allows a coexisting aneurysm and pituitary apoplexy to be simultaneously treated.

【 授权许可】

   
2014 Song et al.; licensee BioMed Central Ltd.

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