title: Spontaneous retroclival hematoma in pituitary apoplexy: case series.
abstract: OBJECTIVE
  Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here.
  
  
  METHODS
  This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension.
  
  
  RESULTS
  Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma.
  
  
  CONCLUSIONS
  Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Avetis
authors.initials: A
authors.lastname: Azizyan
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Ramzi I
authors.initials: RI
authors.lastname: Azzam
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Marcel M
authors.initials: MM
authors.lastname: Maya
authors.affiliation: Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Pouyan
authors.initials: P
authors.lastname: Famini
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Pressman
authors.affiliation: Departments of 1 Imaging and.
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Moser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications* / Q000473:pathology; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000150:complications* / Q000473:pathology; D010902:Pituitary Gland / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: apoplexy; hematoma; hemorrhage; pituitary surgery; retroclival