scholarly journals Pituitary Apoplexy Complicated by Cerebral Infarction: A Case Report

2021 ◽  
Vol 59 (239) ◽  
Author(s):  
Biraj Pokhrel ◽  
Shambhu Khanal ◽  
Parikshit Chapagain ◽  
Gopal Sedain
Keyword(s):  
Cerebral Infarction ◽  
Pituitary Apoplexy ◽  
Rare Complication ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Significant Morbidity ◽  
Sellar Mass ◽  
Tumor Excision ◽  
Orbital Pain ◽  
Left Middle

Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.

scholarly journals Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

2021 ◽  
Author(s):  
Joong-Goo Kim ◽  
Chul-Hoo Kang ◽  
Jay Chol Choi ◽  
Jong-Kook Rhim
Keyword(s):  
Ischemic Stroke ◽  
Saccular Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Digital Subtraction ◽  
Middle Cerebral Artery Territory ◽  
Resonance Imaging ◽  
Ruptured Intracranial Aneurysm ◽  
Acute Confusion ◽  
Subarachnoid Hemorrhages ◽  
Left Middle

A 44-year-old woman presented with acute confusion, apparently due to a clinically silent subarachnoid hemorrhage followed by vasospasm, which in turn led to an ischemic stroke. During the initial evaluation, an acute ischemic stroke in the left middle cerebral artery territory was observed. Magnetic resonance imaging revealed a late subacute hemorrhage in the left basal cistern. Digital subtraction angiography indicated the presence of a small saccular aneurysm that had recently ruptured, as well as vasospasm in the left circle of Willis. Balloon angioplasty and balloon-assisted coil embolization were performed for the vasospasm and saccular aneurysm, respectively. This case demonstrates that clinically silent subarachnoid hemorrhages resulting in ipsilateral vasospasm and infarction can occur as complications of a ruptured aneurysm.

Bee sting leading to stroke: a case report and review of the literature

2021 ◽  
Vol 14 (11) ◽  
pp. e240693
Author(s):  
Shivakumar K Masaraddi ◽  
Rohan J Desai ◽  
Swanit Hemant Deshpande ◽  
Sameet Patel
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Diffusion Mri ◽  
Left Middle Cerebral Artery ◽  
Acute Pulmonary Oedema ◽  
Middle Cerebral Artery Territory ◽  
Review Of The Literature ◽  
Bee Sting ◽  
Local Reactions ◽  
Left Middle

In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.

scholarly journals Bilateral cerebral infarction associated with severe arteriosclerosis in the A1 segment: a case report

2019 ◽  
Vol 47 (3) ◽  
pp. 1373-1377
Author(s):  
Jing Lin ◽  
Wenbiao Xian ◽  
Rong Lai ◽  
Jiaoxing Li ◽  
Yufang Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Large Artery ◽  
Anterior Circulation ◽  
The Right ◽  
Left Middle

Large artery atherosclerosis and cardioembolism are the two major subtypes of ischemic stroke. We herein describe a 75-year-old man with acute complete cerebral infarction in the typical territories of the bilateral anterior cerebral artery (ACA) and left middle cerebral artery. Brain magnetic resonance angiography showed that the right A1 segment of the ACA was affected by severe arteriosclerosis and that the right ACA other than the A1 segment was compensated by the left ACA through the anterior communicating artery. Acute cardioembolism only occluded the left anterior circulation but simultaneously blocked the right ACA due to decompensation. We presume that the bilateral cerebral infarctions were caused by chronic atherosclerosis and acute cardioembolism.

scholarly journals Vasospasm after transsphenoidal adenoma removal: risk factors and new treatment perspectives for this rare event.

2021 ◽  
Vol 47 (1) ◽  
pp. 34-39
Author(s):  
Patricia Lopez Gomez ◽  
David Mato Mañas ◽  
José María Navasa Mellado ◽  
Jaime Viera Artiles ◽  
Sergio Obeso Aguera ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Rare Complication ◽  
Rare Event ◽  
Left Middle Cerebral Artery ◽  
Pituitary Macroadenoma ◽  
Successful Management ◽  
New Treatment ◽  
High Index Of Suspicion ◽  
Left Middle ◽  
Uncommon Complication

Cerebral vasospasm is an uncommon complication following transsphenoidal surgery (TSS) of a pituitary adenoma. Therefore, neither its physiopathology nor its management are clear. We present a case of vasospasm after TSS and we discuss about its etiology and treatment. A 52-year-old woman presented with hirsutism, without neurologic symptoms. A MRI showed a pituitary macroadenoma. The patient underwent an endoscopic transsphenoidal approach. Post-operative CT scan revealed an extensive subarachnoid haemorrhage (SAH). On postoperative 7th day, she developed an abrupt mixed aphasia. An urgent arteriography showed left middle cerebral artery vasospasm, so intra-arterial nimodipine was administered. After that, vasospasm disappeared and the patient recovered completely. The key to successful management of this rare complication is a high index of suspicion. The presence of postoperative SAH seems to definitely contribute to its apparition. Therefore, treatment in concordance with protocols for vasospasm due to aneurysmal SAH is recommended.

Acute stroke in pituitary adenomas complicated by pituitary apoplexy

2016 ◽  
Vol 21 (3) ◽  
pp. 136-139
Author(s):  
Miralim M. Azizov
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Clinical Signs ◽  
Pituitary Tumors ◽  
Clinical Syndrome ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Ischemic Brain ◽  
Left Middle ◽  
Visual Disturbances

Pituitary apoplexy is a clinical syndrome that is manifested by headache, visual disturbances, ophthalmoplegia or impaired consciousness. It can develop as a result of necrosis or hemorrhage in the pituitary gland or in cases of pituitary tumors. A favorable prognosis is possible if early diagnosis and timely surgical treatment. Pituitary apoplexy complicated by the disorder of the cerebral circulation occurs relatively rare. We observed the female patient aged of 51 year with pituitary adenoma, clinical signs of which were sudden depression of consciousness, right hemiparesis and left-sided ptosis. Signs of pituitary apoplexy were revealed after performed examinations. The sharp increase in the size of the tumor resulted in a compression of supraclinoid portion of the left internal carotid artery, which was the cause of ischemic brain damage in the pool left middle cerebral artery. After 2 weeks of conservative treatment, the patient was undergone to the surgery via transsphenoidal access. Histological examination confirmed the hemorrhage and necrosis of the pituitary adenoma. Complication developed 3 months after surgery partially regressed. Taking into account the relatively rare occurrence of pituitary apoplexy complicated with cerebrovascular ischemic type, clinicians should be alert to this complication. The method of choice is transsphenoidal delayed adenomectomy with conservative therapy.

scholarly journals Unusual Evolution and Computerized Tomographic Appearance of a Gliosarcoma

1994 ◽  
Vol 21 (2) ◽  
pp. 141-145
Author(s):  
Mark C. Preul ◽  
Jose A. Espinosa ◽  
Donatella Tampieri ◽  
Stirling Carpenter
Keyword(s):  
Middle Cerebral Artery ◽  
Mass Effect ◽  
Left Middle Cerebral Artery ◽  
Low Grade ◽  
Post Mortem ◽  
Middle Cerebral Artery Territory ◽  
Entire Area ◽  
Central Calcification ◽  
The Brain ◽  
Left Middle

Abstract:A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.

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