title: Chiasmal apoplexy due to hemorrhage from a pituitary adenoma into the optic chiasm: case report.
abstract: OBJECTIVE
  Chiasmal apoplexy, defined as hemorrhage into the optic chiasm, generally is caused by an intrachiasmal vascular malformation. We report the first case of chiasmal apoplexy due to hemorrhage from a pituitary macroadenoma into the optic chiasm.
  
  
  METHODS
  A 52-year-old man presented with headache, sudden and severe deterioration of visual acuity in the left eye, and a bitemporal visual field deficit. Magnetic resonance imaging revealed a large intra- and suprasellar homogeneously enhancing mass, which elevated a markedly thickened optic chiasm. After emergent transsphenoidal resection of the pituitary adenoma, vision did not improve.
  
  
  METHODS
  A pterional craniotomy was subsequently performed, during which a hematoma was found and evacuated from within the substance of the left optic nerve and chiasm. The hematoma cavity was found to communicate with the sella through a defect in the diaphragm. Vision improved dramatically after the operation.
  
  
  CONCLUSIONS
  Chiasmal apoplexy resulting from pituitary adenoma should be distinguished from pituitary apoplexy, particularly because it requires a different surgical treatment. Clinical and radiographic features that may help distinguish the two are discussed.
authors.affiliation: Houston Neurosurgery and Spine Institute, and Neurosurgery Service, Clear Lake Regional Medical Center, Webster, Texas, USA. pakzaban@brokersys.com
authors.forename: P
authors.initials: P
authors.lastname: Pakzaban
authors.forename: K
authors.initials: K
authors.lastname: Westmark
authors.forename: R
authors.initials: R
authors.lastname: Westmark
mesh_terms: D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D003399:Craniotomy; D003937:Diagnosis, Differential; D006801:Humans; D007016:Hypophysectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009897:Optic Chiasm / Q000098:blood supply*; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation