2025 Poster Presentations
P447: PITUITARY APOPLEXY RESULTING IN MASSIVE BILATERAL STROKES AND BRAIN DEATH
Hailey Mattheisen, MS; Abigail Peterson, BS; Stephanie Cheok, MD; Nathan Zwagerman, MD; Medical College of Wisconsin
Introduction: Pituitary apoplexy (PA) is an uncommon but life-threatening condition resulting from sudden expansion of a pituitary tumor due to infarction and/or hemorrhage. The incidence of PA is 0.6%-9% and radiological imaging is paramount for timely diagnosis and surgical intervention. Most often associated with pituitary macroadenomas, clinical symptoms include decrease or loss of vision, headaches, and cavernous sinus syndrome. Stroke following PA is rare, reported in very few cases in literature.
Objective: To present an unusual case of pituitary apoplexy causing immediate vision loss and rapid decline of neurologic exam due to massive bilateral ICA territory stroke. Our discussion focuses on decision-making regarding diagnosis and potential treatment in this difficult case.
Methods: We performed an IRB-approved retrospective review of a patient at our institution.
Results: A 55-year-old previously healthy male presented to our institution for evaluation after experiencing acute vision loss and loss of consciousness. On initial examination, the patient had bilaterally fixed and dilated pupils and extensor posturing. CT revealed a large hemorrhagic pituitary mass with loss of gray and white matter differentiation, and diffuse cerebral edema in the anterior, parietal, and temporal lobes. CT angiogram showed compression and near occlusion of the right clinoidal ICA and similar narrowing on the left side (Figure 1). MRI revealed extensive bilateral infarcts in the MCA and ACA distribution (Figure 2). Given the devastating neurologic exam and massive bilateral infarcts, no surgical intervention was offered, and the patient was declared brain dead 2 days later.
Conclusion: This case highlights an unfortunate complication of pituitary apoplexy – compression and possible inflammatory-mediated vasospasm of clinoidal ICAs resulting in devastating bilateral ischemic strokes. This patient had an atypical presentation for PA and obtaining imaging to better understand the etiology of the patient’s neurologic status is paramount in medical and surgical decision-making.
