Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
JAMA Neurol. 2014 Feb;71(2):226-7. doi: 10.1001/jamaneurol.2013.4528.
Cerebral ischemia due to pituitary apoplexy is very rare. It may be caused by vasospasm or direct compression of cerebral vessels by the expanding mass. Bilateral caudate infarcts also are very rare. To our knowledge, this is the first case report that presents pituitary apoplexy causing compression of bilateral anterior cerebral artery branches and leading to bilateral caudate infarcts.
An 81-year-old woman with a pituitary macroadenoma presented with circulatory shock due to pituitary apoplexy. Neurological examination revealed new asymmetric quadriparesis with chronic bilateral visual disturbance. On brain magnetic resonance imaging, she was found to have watershed infarcts in the anterior cerebral artery-middle cerebral artery and middle cerebral artery-posterior cerebral artery watershed zones in addition to bilateral caudate infarcts.
Pituitary apoplexy can cause compression of bilateral anterior cerebral arteries from the expanding mass and lead to bilateral caudate infarcts. It is important to understand the pathophysiology of cerebral ischemia in pituitary apoplexy to improve management.
垂体卒中引起的脑缺血非常罕见。它可能是由血管痉挛或扩张的肿块直接压迫脑血管引起的。双侧尾状核梗死也非常罕见。据我们所知，这是首例报道的垂体卒中导致双侧大脑前动脉分支受压，进而导致双侧尾状核梗死的病例。
一位 81 岁的女性患有垂体大腺瘤，因垂体卒中导致循环休克。神经系统检查显示新出现的非对称四肢瘫痪，伴有慢性双侧视力障碍。脑磁共振成像显示，除了双侧尾状核梗死外，她还在前大脑中动脉-大脑中动脉和大脑中动脉-大脑后动脉分水岭区域存在分水岭梗死。
垂体卒中可导致扩张肿块压迫双侧大脑前动脉，从而导致双侧尾状核梗死。了解垂体卒中引起脑缺血的病理生理学对于改善管理非常重要。
