Cerebral Ischaemia in Pituitary Apoplexy

Abstract

Natural course of pituitary tumour may get interrupted by an apoplectic event within pituitary tumour. Pituitary apoplexy is a classical syndrome characterized by sudden-onset headache, signs of meningeal irritation, visual impairment and ophthalmoplegia due to acute enlargement of a pituitary adenoma caused by haemorrhage or infarction. Inadvertently, such an intra-tumoural haemorrhage spills over into subarachnoid space causing radiological images masquerading aneurysmal subarachnoid haemorrhage. Pathophysiology of cerebral ischaemia after such a catastrophic event in pituitary tumour remains far from established. Cerebral vasospasm and mechanical obstruction of large vessels of circle of Willis are the two major presumptive causative factors behind vascular compromise. In this chapter, we will describe the incidence, pathophysiology, clinical symptomatology, radiological investigations and management strategies aimed at treating such a rare cause of cerebral ischaemia.