Pituitary Apoplexy with Hemiparesis and Pleocytosis

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Abstract
A case of pituitary apoplexy was reported. A 17-year-old patient was admitted with a 3-day history of headache, vomiting, high fever, neck stiffness, consciousness disturbance, visual disturbance, ophthalmoplegia, and left hemiparesis. He appeared to be acromegalic. The cerebrospinal fluid contained numerous polymorphonuclear cells. CT showed a large, high-density suprasellar mass. Meningitis due to rupture of an abscess in a pituitary adenoma was suspected, but conservative chemotherapy was not effective. On the 5th hospital day he became comatose, and CT showed an extensive hypodense lesion with mass effect in the right cerebral hemisphere. Although decompressive craniectomy was performed, he died 13 days after the onset. Postmortem examination revealed that a large suprasellar pituitary adenoma with massive intratumoral hemorrhage had compressed the right intracranial internal carotid artery and had caused extensive infarction of the ipsilateral cerebral hemisphere. The tumor was a mixed adenoma consisting of chromophobe and eosinophilic cells, and immunohistochemical study showed the presence of growth hormone-producing adenoma cells. There was no evidence of intracranial infection.

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