Case report
Coexistence of aneurysmal subarachnoid haemorrhage and pituitary apoplexy: Case report and review of the literature

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Abstract

A case of aneurysmal subarachnoid haemorrhage with associated haemorrhagic infarction of a growth hormone secreting pituitary macroadenoma is presented. The subarachnoid haemorrhage was not identifiable on CT, but was apparent on MRI. Angiography revealed a 7 mm right posterior communicating aneurysm, a 3 mm left A1 segment anterior cerebral aneurysm, and vasospasm. Surgery was performed through a right pterional/subfrontal approach, clipping both aneurysms and debulking the tumour. The left A1 aneurysm was the site of subarachnoid haemorrhage. There was evidence of haemorrhagic infarction of the pituitary tumour. Although rupture of an aneurysm into a pituitary tumour has been previously reported, this is the first case reported of aneurysmal subarachnoid haemorrhage with coexisting pituitary apoplexy where the aneurysm had not bled directly into the pituitary tumour. The literature regarding the association between pituitary tumours and aneurysm is reviewed.

Section snippets

Case report

This 51 year old, previously healthy, left handed female presented four days after sudden loss of consciousness while showering, followed by a global headache and general malaise and later vomiting. She did not report neck stiffness or photophobia, although she noted her vision, which had been poor particularly in the left eye for 2 years, was blurred. She remained independent and had improving symptoms until day 4 following the initial collapse, when she again felt generally unwell and had

Discussion

The term pituitary apoplexy has been traditionally applied to the sudden onset of symptoms (typically visual deterioration, extraocular palsies, headache or altered conscious state) associated with haemorrhage (usually haemorrhagic infarction) into, or occasionally infarction of, a pituitary adenoma.[1], [2], [3], [4] However, many reports have not distinguished between this acute clinical entity and subclinical haemorrhage into a pituitary adenoma not associated with acute presentation

Conclusion

Although the association of pituitary tumour and aneurysm might not be more frequent than chance coexistence, the diagnostic difficulties and treatment implications of this not infrequent association are such that it must be considered in all cases of parasellar lesions, particularly with acute presentation. MRI and DSA provide essential information in such cases. Craniotomy allows coexisting aneurysm and pituitary macroadenomas to be simultaneously treated.

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