Korean J Neurotrauma.  2012 Apr;8(1):55-57. 10.13004/kjnt.2012.8.1.55.

Atypical Presentation of Acute Pituitary Apoplex Following Mild Head Injury

• Jang HJ
• Jwa CS

• KMID: 1427685
• DOI: http://doi.org/10.13004/kjnt.2012.8.1.55

Abstract

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.

Keyword

Head injury; Pituitary apoplexy; Pituitary tumor

MeSH Terms

Consciousness
Contusions
Craniocerebral Trauma
Female
Fever
Glasgow Coma Scale
Head
Headache
Hemorrhage
Humans
Pituitary Apoplexy
Pituitary Neoplasms
Prosencephalon
Scalp
Shock
Skull Fractures

Figure

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  FIGURE 1. Initial computed tomography (CT) and magnetic resonance image (MRI) of the brain. Axial CT (A) and axial image of MRI (B) show multiple hemorrhagic contusions in the frontal base, falx hemorrhage and a suprasellar-extended pituitary macroadenoma with intratumoral hemorrhage (white arrows).

• 

  FIGURE 2. Initial (A, C) and follow-up (B, D) MRI of the brain. T1- and T2-weighted sagittal images (B, D) four months after head injury reveal total regression of pre-existing pituitary macroadenoma after pituitary apoplexy.

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