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Case Report/Case Series |

Unusual Case of Bilateral Caudate Infarcts Following Pituitary Apoplexy

Tania Rebeiz, MD1; Wilson Cueva, MD1; Agnieszka Ardelt, MD, PhD1
[+] Author Affiliations
1Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
JAMA Neurol. 2014;71(2):226-227. doi:10.1001/jamaneurol.2013.4528.
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Importance  Cerebral ischemia due to pituitary apoplexy is very rare. It may be caused by vasospasm or direct compression of cerebral vessels by the expanding mass. Bilateral caudate infarcts also are very rare. To our knowledge, this is the first case report that presents pituitary apoplexy causing compression of bilateral anterior cerebral artery branches and leading to bilateral caudate infarcts.

Observations  An 81-year-old woman with a pituitary macroadenoma presented with circulatory shock due to pituitary apoplexy. Neurological examination revealed new asymmetric quadriparesis with chronic bilateral visual disturbance. On brain magnetic resonance imaging, she was found to have watershed infarcts in the anterior cerebral artery–middle cerebral artery and middle cerebral artery–posterior cerebral artery watershed zones in addition to bilateral caudate infarcts.

Conclusions and Relevance  Pituitary apoplexy can cause compression of bilateral anterior cerebral arteries from the expanding mass and lead to bilateral caudate infarcts. It is important to understand the pathophysiology of cerebral ischemia in pituitary apoplexy to improve management.

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Figure.
Pituitary Apoplexy Causing Compression of the Anterior Cerebral Vasculature and Leading to Cerebral Ischemia

A, Axial, gradient-echo magnetic resonance image of the brain showing hemorrhage within the sellar mass (arrowhead). B, Axial diffusion-weighted magnetic resonance image of the brain showing infarcts in the anterior cerebral artery–middle cerebral artery watershed zones. C, Axial magnetic resonance image of the brain showing a sellar-based mass anteriorly displacing the bilateral anterior cerebral arteries (arrowheads). D, Axial diffusion-weighted magnetic resonance image of the brain showing infarcts in the bilateral caudate nuclei.

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