Pituitary Apoplexy Presenting With Magnetic Resonance Angiogram–Negative Subarachnoid Hemorrhage: A Diagnostic and Therapeutic Challenge
Muhieddine Doughan, Rosette JabbourBackground
Pituitary apoplexy is a neurosurgical emergency that may rarely coexist with subarachnoid hemorrhage (SAH), creating significant diagnostic and management challenges, particularly when an underlying aneurysm is not identified.
Case Presentation
A 68‐year‐old woman presented with acute severe headache and hypertensive crisis. Brain MRI demonstrated a pituitary macroadenoma, along with associated SAH. Magnetic resonance angiography did not reveal any intracranial aneurysm. The patient experienced rapid neurological deterioration with a decreased level of consciousness, necessitating intubation and intensive care management. Cerebrospinal fluid analysis confirmed xanthochromia. In the absence of an identifiable vascular lesion, the patient underwent craniotomy and subtotal macroadenoma resection. The patient then had remarkable neurological improvement after the surgery.
Discussion
The coexistence of pituitary apoplexy and angiogram‐negative SAH is rare and may mimic aneurysmal rupture. The surgical strategy must account for diagnostic uncertainty, as transsphenoidal approaches may be insufficient when concomitant vascular pathology cannot be definitively excluded.
Conclusion
This case underscores the importance of considering pituitary apoplexy in atypical SAH presentations and highlights the role of individualized surgical planning. Early intervention can lead to favorable neurological outcomes despite the complex presentation.