Wende T, Hamerla G, Quäschling U, Haase A, Meixensberger J, Nestler U. Persistent hyperprolactinemia, transient hypopituitarism, and transient contralateral third nerve palsy after endovascular treatment of an internal carotid artery aneurysm: Case report and review of the literature.
SAGE Open Med Case Rep 2020;
8:2050313X20948714. [PMID:
32922793 PMCID:
PMC7457645 DOI:
10.1177/2050313x20948714]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 11/11/2022] Open
Abstract
Intracranial aneurysms have an estimated prevalence of about 3%. A rare subgroup
are aneurysms of the internal carotid artery that develop medially into the
sellar region. Due to the risk of rupture with subsequent subarachnoid
hemorrhage and of compression of surrounding structures, mechanical occlusion is
advised. Hypopituitarism is not a rare disease and most often related to
pituitary adenoma. Only 0.17% of cases with hypopituitarism are caused by
unruptured intracranial aneurysms. Today, the predominant treatment of these
aneurysms is endovascular coiling or application of flow diverting stents. We
present the case of a 60-year-old female patient, who was treated with
endovascular coiling for a right-sided, intracavernous, incidental internal
carotid artery aneurysm. On postinterventional day 6, she was readmitted with
contralateral third nerve palsy, mild hyponatremia und thyreotropic
insufficiency. The symptoms recovered after anti-edematous treatment with
corticosteroids; only an asymptomatic hyperprolactinemia persisted. To the best
of our knowledge, this is the first case report of transient contralateral
cranial nerve palsy combined with transient hypopituitarism after endovascular
treatment of an internal carotid aneurysm. As treatment we propose
corticosteroids, if necessary in combination with nonsteroidal anti-inflammatory
drugs, in order to inhibit inflammatory reactions of the aneurysm wall
compromising the nearby, partially compressed neural structures.
Collapse