뇌하수체 졸중과 뇌동맥류가 공존하는 지주막하출혈

Abstract

Pituitary apoplexy presenting with subarachnoid hemorrhage (SAH) is rare and thus may be easily mistaken for aneurysmal rupture. So, It has clinical significancy because of different treatment compared with aneurysmal SAH, especially co-existent pituitary apoplexy and cerebral aneurysm in SAH. We report a case of co-existent pituitary apoplexy and cerebral aneurysm in SAH. A 86-year-old woman presented with sudden headache, vomiting and drowsiness. CT showed diffuse SAH in interhemispheric and basal cisterns, widening of pituitary fossa and intrasella mass with suprasella extension. MRA showed an about 2 mm sized aneurysm at the right MCA bifurcation and elevation of both ACA A1 due to mass effect of the pituitary apoplexy. Craniotomy was performed and we could find that SAH due to pituitary apoplexy and co-existed unruptured right MCA aneurysm. We stress that pituitary apoplexy must be included in the differential diagnosis of SAH, and proper preoperative radiologic imaging and careful interpretation is demanded for accurate diagnosis and appropriate treatment.