Pituitary apoplexy

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Sudden severe headaches with left ophthalmoplegia in a patient known for a pituitary mass.

Patient Data

Age: 55 years
Gender: Male
mri

There is a large sellar mass with suprasellar extension filling the optochiasmatic cistern and elevating the optic chiasma. It elicits a large central area of high signal on T1 and T2 with fluid-fluid level best seen on postcontrast sagittal T1 with no enhancement on postcontrast sequences, suggestive of hemorrhagic infarction.

Case Discussion

The clinical presentation and the MRI features in a patient with a pre-existing pituitary macroadenoma are most consistent with pituitary apoplexy.

Pituitary apoplexy is an acute clinical syndrome caused by either hemorrhage or infarction of the pituitary gland. Although variable, it typically comprises a headache, visual deficits, ophthalmoplegia, and altered mental status. An existing pituitary macroadenoma is usually present (60-90%) but it can occur with healthy glands in a few isolated cases. 

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