A potential catastrophic trap: an unusually presenting sellar lesion.
A 63-year-old man was admitted to our emergency unit complaining headache, vomit and vertigo. A MR of the brain showed an expanding lesion within the sellar region. A subsequent angio-MR excluded any intracranial vascular malformations. Surprisingly, a cerebral angiography performed later on the basis of worsening of neurological signs and symptoms, demonstrated an aneurysm of the internal carotid artery. At the best of our knowledge, this is the first case of a thrombosis of an intracavernous carotid aneurysm mimicking a pituitary apoplexy documented by MR and angio-MR. The treatment of a milder syndrome of pituitary apoplexy is still controversial. This case would favour conservative treatment opposed to surgery at least when an intracavernous extension or invasion of the adenoma would limit the opportunity of a complete tumour removal.
Neurosurgical Department, Fondazione Ospedale Maggiore IRCCS, Policlinico Mangiagalli e Regina Elena, University of Milan, Milano, Italy.
M
M
Locatelli
D
D
Spagnoli
M
M
Caroli
M
M
Isalberti
V
V
Branca
S M
SM
Gaini
A
A
Lania
D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010899:Pituitary Apoplexy / Q000175:diagnosis*; D010902:Pituitary Gland / Q000473:pathology / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000175:diagnosis; D012658:Sella Turcica / Q000473:pathology*; D014717:Vertigo / Q000209:etiology