Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report

Introduction and importance Pituitary apoplexy is defined as a sudden onset of neurologic deficit due to infarction or hemorrhage of the pituitary tumor. We report a case of emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction due to ICA compression in a limited resources condition. Case presentation A 38-year-old female presented with acute onset of severe headache, decreased level of consciousness, decreased visual acuity bilaterally, aphasia, and right hemiparesis. Computed tomography angiography showed a hyperdense sellar mass with stenosis of the left ICA. The patient underwent emergent endoscopic transsphenoidal surgery for sellar decompression. Clinical discussion The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. Conclusion Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. Pituitary apoplexy presenting as cerebral infarction is rare. The aim of surgery in emergency setting was sellar decompression. Endoscopic transsphenoidal surgery was an effective treatment.
Highlights • Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. • Pituitary apoplexy presenting as cerebral infarction is rare. • The aim of surgery in emergency setting was sellar decompression. • Endoscopic transsphenoidal surgery was an effective treatment.