Banerjee Christopher, Snelling Brian, Hanft Simon, Komotar Ricardo J
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA,
Pituitary. 2015 Jun;18(3):352-8. doi: 10.1007/s11102-014-0581-x.
Pituitary tumor apoplexy (PTA) is a potentially fatal condition caused by hemorrhage and rapid expansion of a pituitary tumor. One rare consequence of PTA is occlusion of the intracavernous carotid arteries, very rarely leading to cerebral infarction.
To describe a case of PTA leading to bilateral cerebral infarction and provide an extensive literature review of all previously reported cases of PTA leading to cerebral infarction. We discuss how these cases contribute to our understanding of the management of PTA, and we also discuss the differences between cases associated with the reported mechanism of carotid occlusion (compression vs. vasospasm).
A 56-year-old previously healthy woman complained of severe headache and visual loss one day after sustaining a fall from standing. Computed tomography demonstrated an enlarged sellar and suprasellar mass displacing both cavernous ICAs laterally, with multiple bilateral hypodense areas in the ICA distribution consistent with infarction. She clinically deteriorated and underwent endoscopic transsphenoidal gross total resection for suspected PTA within 48 hours after falling. Her prognosis remained poor after 5 days, and support was withdrawn.
Twenty-four cases of PTA leading to cerebral infarction have been previously documented-four bilateral, our case being the fifth. Based on our review, the presence of infarction itself does not seem to warrant surgical management in the absence of previously established indications for surgery (such as a deteriorating visual field), despite a 3-5 times mortality increase. No conclusion regarding the role of the mechanism of occlusion can be made at this time.
垂体瘤卒中（PTA）是一种由垂体瘤出血和迅速增大引起的潜在致命性疾病。PTA的一种罕见后果是海绵窦内颈动脉闭塞，极少导致脑梗死。
描述1例导致双侧脑梗死的PTA病例，并对所有先前报道的导致脑梗死的PTA病例进行广泛的文献综述。我们讨论这些病例如何有助于我们理解PTA的治疗，并且我们还讨论与报道的颈动脉闭塞机制（压迫与血管痉挛）相关的病例之间的差异。
一名56岁既往健康的女性在从站立位摔倒一天后出现严重头痛和视力丧失。计算机断层扫描显示鞍内和鞍上肿块增大，将双侧海绵窦内颈内动脉向外推移，颈内动脉分布区有多个双侧低密度区，符合梗死表现。她的临床症状恶化，在摔倒后48小时内接受了内镜经蝶窦大体全切术，以治疗疑似PTA。5天后她的预后仍然很差，于是停止了支持治疗。
先前已记录了24例导致脑梗死的PTA病例——4例为双侧梗死，我们的病例是第5例。根据我们的综述，在没有先前确定的手术指征（如视野恶化）的情况下，梗死本身似乎并不足以保证进行手术治疗，尽管死亡率增加了3至5倍。目前无法就闭塞机制的作用得出结论。
