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Subarachnoid hemorrhage due to pituitary adenoma apoplexy—case report and review of the literature

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Abstract

Pituitary apoplexy (PA) may be complicated by development of subarachnoid hemorrhage (SAH). We conducted a literature review to evaluate the rate of PA-associated tumor rupture and SAH. We conducted a systematic literature search (PubMed, Web of Science, Medline) for patients with PA-associated SAH and report a case SAH following PA. Suitable articles, case series, and case reports were selected based on predefined criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We reviewed included publications for clinical, radiological, surgical, and histopathological parameters.We present the case of a patient with PA developing extensive SAH whilst on the MRI who underwent delayed transsphenoidal resection. According to our literature review, we found 55 patients with a median age of 46 years; 18 (32.7%) were female. Factors associated with PA-related SAH were hypertension, diabetes mellitus, prior trauma, anticoagulant, and/or antiplatelet therapy. The most common presenting symptoms included severe headache, nausea and/or vomiting, impaired consciousness, and meningeal irritation. Acute onset was described in almost all patients. Twenty-two of the included patients underwent resection. In patients with available outcome, 45.1% had a favorable outcome, 10 (19.6%) had persisting focal neurological deficits, 7 developed cerebral vasospasms (12.7%), and 18 (35.3%) died. Mortality greatly differed between surgically (9.1%) and non-surgically (44.8%) treated patients. PA-associated SAH is a rare condition developing predominantly in males with previously unknown macroadenomas. Timely surgery often prevents aggravation or development of severe neuro-ophthalmological defects and improves clinical outcome.

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Author notes

  1. Marian Christoph Neidert and Isabel Charlotte Hostettler contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Yesim Yildiz, Oliver Bozinov, Marian Christoph Neidert & Isabel Charlotte Hostettler

  2. Department of Neuroradiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Arno Lauber

  3. Department of Neuropathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Natalia Velez Char

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  1. Yesim Yildiz
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Correspondence to Isabel Charlotte Hostettler.

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Yildiz, Y., Lauber, A., Char, N.V. et al. Subarachnoid hemorrhage due to pituitary adenoma apoplexy—case report and review of the literature. Neurol Sci 45, 997–1005 (2024). https://doi.org/10.1007/s10072-023-07130-y

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