An interesting case of a pituitary adenoma apoplexy mimicking an acute meningitis. Case report.
Apoplexy of a pituitary adenoma is a rare and under-diagnosed clinical occurrence. It results from either infarction or haemorrhage into an adenoma of the pituitary gland. Its clinical presentation more often includes rapid development of impaired consciousness, severe headache, visual disturbance and variable association of oculomotor nerve palsy. Meningeal irritation signs are considered very rare and usually not reported as presenting symptoms. A 33-year-old male suffered a pituitary macroadenoma apoplexy, clinically indistinguishable from an infectious meningitis at presentation. Three days after surgery, the patient developed a left ophthalmoplegia due to 3(rd) nerve palsy, which fully resolved within 2 months. A right pterional craniotomy was performed during which complete tumour removal was achieved. In conclusion the authors believe that, despite many reports in the literature, encouraging conservative management in pituitary apoplexy by administering intravenous steroids, surgery should be undertaken in order to avoid eventual visual field defects, relieve pituitary gland compression and prevent a possible recurrent apoplectic episode or tumor re-growth.
Chibbaro
S
S
Division of Neurosurgery, Spedali Riuniti, Livorno, Italy. schibbaro@hotmail.com
Benvenuti
L
L
Carnesecchi
S
S
Faggionato
F
F
Gagliardi
R
R
D000208:Acute Disease; D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D020520:Brain Infarction / Q000150:complications / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D006261:Headache / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis*; D019547:Neck Pain / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods; D015840:Oculomotor Nerve Diseases / Q000209:etiology; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010902:Pituitary Gland / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D006854:Hydrocortisone