gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Pituitary apoplexia associated with SAH due to a ruptured AcoA aneurysm

Koinzidenz eines Hypophysenapoplex mit einer SAB aus einem rupturierten AcoA-Aneurysma

Meeting Abstract

Suche in Medline nach

  • corresponding author T. Eichmann - Neurochirurgische Klinik, Diakoniekrankenhaus Rotenburg/Wümme
  • C. Groß - Neurochirurgische Klinik, Diakoniekrankenhaus Rotenburg/Wümme
  • H. Kolenda - Neurochirurgische Klinik, Diakoniekrankenhaus Rotenburg/Wümme

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP121

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 4. Mai 2005

© 2005 Eichmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.




We report the rare case of pituitary apoplexia associated with a simultaneously ruptured AcoA aneurysm. Such an acute coincident pathology has not been reported until now.


A 71-year-old women with one-year history of prolonged visual deficits presented with abrupt onset of headache, nausea, vomiting, complete loss of vision and ophthalmoplegia. There were no previous clinical signs of endocrine disturbance. Initial CT-scan showed a large contrast enhancing intra- and suprasellar mass including hemorrhages. The diagnosis of pituitary apoplexia was obvious. In addition a subarachnoid hemorrhage located in the frontal interhemispheric fissure and a small parenchymal hematoma in the right gyrus rectus was found. 3D reconstructed Computed tomography angiography showed a suspicious bulge at the AcoA junction but no definite cerebral aneurysm.


Due to the acute onset of complete amaurosis we performed an emergency transcranial operation via a pterional approach without further investigations. After decompression of the suprasellar tumor, a saccular aneurysm of the AcoA fixed to the tumor was exposed. There was obviously a concomitatnt SAH. The aneurysm was clipped and the tumor was completely removed releasing the chiasm and optic nerve. Postoperatively the patient presented a transient diencephalic syndrome but her clinical course improved with slight neuropsychological deficits. Ophthalmoplegia receded but the visual deficits persisted.


We assume that the rupture of the aneurysm was caused by the acutely increased tension of the tumor capsule originated by the bleeding of the pituitary adenoma. Since the association of an acute hemorrhage into a giant pituitary adenoma associated with the rupture of an AcoA aneurysm is a very rare event, there are no standard recommendations for the diagnostic and therapeutic management. When SAH is present in pituitary apoplexia, one should consider this combination and be prepared for it.