Cerebral infarction following pituitary apoplexy - Case report
Cerebral infarction following pituitary apoplexy - Case report
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DOI：
10.2176/nmc.44.479
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发表时间：
2004-09-01
影响因子：
1.9
通讯作者：
Matsumura, A
中科院分区：
文献类型：
--
作者：
Akutsu, H;Noguchi, S;Matsumura, A
一位29岁的男性表现为嗜睡、头痛、高烧和视力障碍。神经系统检查显示瞳孔散大，上睑下垂，对光反射减弱，左侧眼肌麻痹。磁共振（MR）成像显示了垂体中风的典型表现，脑血管造影显示左大脑前动脉（ACA）A段轻度狭窄。经蝶窦肿瘤切除术。手术后立即发生短暂的严重右侧轻偏瘫。计算机断层扫描显示左Heubner动脉和内侧纹状体动脉区域发生脑梗死。中风后并发脑梗塞是非常罕见的。ACA穿支血管痉挛可能是脑梗死的原因。蛛网膜下腔血液或肿瘤释放的血管活性物质是血管痉挛的最可能原因。血管周围增强的MRI表现可能提示血管周围的反应性病变。
A 29-year-old man presented with lethargy, headache, high fever, and visual disturbance. Neurological examination showed mydriatic pupil, ptosis, diminished light reflex, and ophthalmoplegia on the left. Magnetic resonance (MR) imaging showed the typical findings of pituitary apoplexy, and cerebral angiography disclosed mild narrowing of the A, segment of the left anterior cerebral artery (ACA). Transsphenoidal tumor resection was performed. Transient severe right hemiparesis occurred directly after the operation. Computed tomography demonstrated cerebral infarction in the territory of the left Heubner's and medial lenticulostriate arteries. Pituitary apoplexy followed by cerebral infarction is very rare. Vasospasm of the perforating arteries of the ACA probably caused the cerebral infarction. Subarachnoid blood or vasoactive agents released from the tumor were the most likely cause of the vasospasm. MR imaging findings of contrast enhancement around the vessels may indicate reactive processes around the vessels.