Case Report

Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache

Figure 1

Brain MRI W/WO contrast 2 days before surgery. (a) Coronal T1-weighted image demonstrates a large sellar mass with suprasellar extension and slight mass effect on the optic chiasm. This mass exhibits marked hyperintense signal on T1-weighted image (arrow), which indicates blood products and recent hemorrhage. (b) Coronal T1-weighted postcontrast image shows normal enhancement of the cavernous sinus. No enhancing mass or nodule is evident in association with intrinsically T1 bright lesion. The mass abuts approximately 90 degrees of the right internal carotid artery contour. This abutment is less on the left side. The carotid arteries are patent and show normal caliber without any narrowing. No normal pituitary tissue is identified.
(a)
(b)