Recurrent lymphocytic hypophysitis and bilateral intracavernous carotid artery occlusion. an observation and review of the literature.
OBJECTIVE
Bilateral carotid artery occlusion associated with lymphocytic hypophysitis is exceedingly rare. We describe this association and review the literature.


METHODS
The authors describe a 38-year-old woman with a history of severe headaches. Magnetic resonance (MR) imaging showed an intrasellar mass with invasion of both cavernous sinuses. Lymphocytic hypophysitis was diagnosed by transphenoidal biopsy. In the course of the disease, she developed symptoms of cerebral ischemia attributable to bilateral occlusion of her internal carotid arteries in both cavernous sinuses. She underwent bilateral superficial temporal artery-middle cerebral artery bypass surgery.


RESULTS
The patient experienced progressive neurological recovery after surgery. A literature search revealed no other cases describing this unique association.


CONCLUSIONS
Bilateral carotid artery occlusion may develop in the course of lymphocytic hypophysitis with cavernous sinus involvement. If indicated, cerebral revascularization should be performed to reverse cerebral ischemia.
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. mmelgar@tulane.edu
Miguel A
MA
Melgar
Nitin
N
Mariwalla
David S
DS
Gloss
John W
JW
Walsh
D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002426:Cavernous Sinus / Q000473:pathology* / Q000503:physiopathology; D004660:Encephalitis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008218:Lymphocytosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D020768:Middle Cerebral Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D010900:Pituitary Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011859:Radiography; D012658:Sella Turcica / Q000473:pathology / Q000503:physiopathology; D013699:Temporal Arteries / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures