57 y/o woman with sudden onset of headache, high fever and weakness

 

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Doctor's Information

Name : morteza
Family : sanei taheri
Affiliation :Radiology Department ,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : hadi zolfeghari

 

Case Section

Head & Neck Imaging

 

Patient's Information

Gender : Female
Age : 57

 

Clinical Summary

57 y/o woman with sudden onset of headache, high fever and weakness

 

Imaging Findings

MRI demonstrated Pituitary mass at the sella continueing to supracella region with intra-tumoral hemorrhage seen on axial MRI T1W and T2WI . The hemorrhagic component is hyperintense on T1-weighted image, heterogeneous on T2-weighted image. Acute cerebral infarction involving Rt ACA teritory showed on axial MRI as hyperintensity on DWI sequence and hypointensity on corresponding ADC map. Rt ICA & ACA signal changes are noted. After contrast administration, Rt ICA is enhance due to partial narrowing and delay passage.

 

Differential Diagnosis

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Final Diagnosis

pituitary tumor apoplexy with vascular involvement

 

Discussion (Related Text)

Pituitary apoplexy is rare endocrine emergency which can occur due to infarction or hemorrhage of pituitary gland. This disorder most often involves a pituitary adenoma. Occasionally it may be the first manifestation of an underlying adenoma. Rarely pituitary apoplexy causes vascular infarction.

 

References

1. Rajasekaran S, Venderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy. Pituitary apoplexy guidelines development group: May 2010. Clinical Endocrinology 2011; 74: 9-20.
2. Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med. Mar-Apr 2008;23(2):75-90. [Medline].
3. Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol. Sep 1982;18(3):181-9. [Medline].

 

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