Radiological features of internal carotid artery occlusion caused by pituitary apoplexy: illustrative case.

BACKGROUND: Pituitary apoplexy rarely causes internal carotid artery (ICA) occlusion and acute ischemic stroke. Some cases have been reported, but the neuroimaging findings, including cerebral angiography, have not been discussed. OBSERVATIONS: A 55-year-old male suffered the sudden onset of right cervical pain and left mild hemiparesis. Computed tomography indicated a pituitary mass, and magnetic resonance angiography showed a right ICA occlusion. The initial diagnosis was ICA occlusion caused by ICA dissection. His symptoms worsened and the region of cerebral infarction expanded, so the patient was transferred to our hospital. Magnetic resonance imaging and cerebral angiography showed the sudden stoppage of right ICA blood flow caused by local compression of the tumor near the distal dural ring. The diagnosis was acute ischemic stroke resulting from ICA pseudo-occlusion caused by pituitary apoplexy, and emergent endoscopic transsphenoidal resection was performed. Postoperatively, the right ICA was completely patent, and hemiparesis was improved with rehabilitation. LESSONS: ICA occlusion caused by pituitary apoplexy is very rare, but emergent treatment is necessary. However, the pathology is difficult to diagnose quickly. Neuroimaging findings showing that the ICA is easily stenosed or occluded if rapidly compressed by the tumor near the distal dural ring may be useful to rapidly diagnose and treat.

Endovascular Treatment of Patients with Oculomotor Nerve Palsy Induced by Posterior Communicating Artery Aneurysms.

Objective: Whether coiling is the best treatment option for oculomotor nerve palsy (ONP) induced by posterior communicating artery (PComA) aneurysms remains controversial. In this study, we retrospectively analyzed the recovery of ONP caused by PComA aneurysms. Methods: Between 2007 and 2019, 8 patients with PComA aneurysms and ONP underwent coiling at our institution. We retrospectively reviewed ONP recovery, duration from onset of ONP to treatment, and complications of procedures. Results: At the last available clinical follow-up, ONP recovery was complete in 4 patients (50%) and partial in 4 patients (50%). Patients with partial recovery of ONP had sequelae of eye movement impairment that did not affect daily life. In 1 patient, hemiplegia developed due to cerebral infarction of the corona radiata the day after coiling, but it fully recovered 1 year after operation. The delay from the onset of ONP to coiling was significantly related to partial ONP recovery (r = -0.83, p = 0.01). Conclusion: Endovascular treatment is a relatively safe and satisfactory treatment for PComA aneurysms with ONP.

[Rupture of small intestinal varices diagnosed by CTAP and gastrointestinal bleeding scintigraphy and treated by percutaneous phlebosclerozation angioembolization].

A 55-year-old man was admitted to our hospital because of massive gastrointestinal bleeding. He had a history of type B liver cirrhosis, multiple abdominal surgeries, and endoscopic treatment of esophageal varices. Colonoscopy was performed, but the source of bleeding could not be identified. Computed tomography during arterial portography (CTAP) demonstrated small intestinal varices and collateral veins from the superior mesenteric vein to the epigastric vein. We performed phlebosclerozation by directly puncturing the epigastric vein under the skin. Remission of bleeding was then attained. No recurrence of gastrointestinal hemorrhage has occurred after the phlebosclerozation. We believe that CTAP is useful when diagnosing small intestinal varices and that percutaneous phlebosclerozation should be considered as a treatment option for small intestinal varices.