J Korean Med Sci.  2007 Dec;22(6):1085-1089. 10.3346/jkms.2007.22.6.1085.

Pituitary Apoplexy Complicated by Chemical Meningitis and Cerebral Infarction

• Jeon BC
• Park YS
• Oh HS
• Kim YS
• Chun BK

• KMID: 1785776
• DOI: http://doi.org/10.3346/jkms.2007.22.6.1085

Abstract

A 41-yr-old man was admitted with acute headache, neck stiffness, and febrile sensation. Cerebrospinal fluid examination showed pleocytosis, an increased protein level and, a decreased glucose concentration. No organisms were observed on a culture study. An imaging study revealed pituitary macroadenoma with hemorrhage. On the 7th day of the attack, confusion, dysarthria, and right-sided facial paralysis and hemiparesis were noted. Cerebral infarction on the left basal ganglia was confirmed. Neurologic deficits gradually improved after removal of the tumor by endoscopic transnasal transsphenoidal approach. It is likely that the pituitary apoplexy, aseptic chemical meningitis, and cerebral infarction are associated with each other. This rare case can serve as a prime example to clarify the chemical characteristics of pituitary apoplexy.

Keyword

Cerebral Infarction; Meningitis; Pituitary Apoplexy

MeSH Terms

Adenoma/*complications
Adult
Cerebral Infarction/*etiology
Humans
Magnetic Resonance Imaging
Male
Meningitis/*etiology
Pituitary Apoplexy/*complications/etiology
Pituitary Neoplasms/*complications
Tomography, X-Ray Computed

Figure

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  Fig. 1 (A) T1-weighted non-enhanced coronal magnetic resonance imaging (MRI) shows a pituitary mass with increased focal signal intensity that reflects intratumoral hemorrhage. (B) T1-weighted enhanced coronal MRI shows strong enhancement of the pituitary tumor extending to the left cavernous sinus, but not compromising the optic chiasm. (C) Enhanced axial image of MRI shows a high signal intensity lesion and a small cystic area. (D) There is no hemorrhage in the subarachnoid space of the basal cistern on an initial computerized tomography scan.

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  Fig. 2 (A) On the 7th day of pituitary apoplexy, non-contrast computerized tomography scan shows low density on deep nuclei and internal capsule. (B) Diffusion-weighted image of magnetic resonance imaging scan reveals hyperintense infarction in the same area.

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  Fig. 3 Histology of pituitary adenoma reveals hemorrhagic infarct with necrotic neoplastic cells and congested vessels supporting the diagnosis of pituitary apoplexy (H&E stain, ×200).

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