1999 Resident Poster Competition
Motaz Alshaher M.D.
St. Luke's Medical Center
Pituitary Apoplexy Presenting as Aseptic Meningitis, Case Report
Pituitary apoplexy is a rare disease resulting from hemorrhage into a pituitary tumor. It characteristically presents as a sudden onset of headache, partial ophthalmoplegia and blindness.
We present a 43 year-old female who came in with nausea, vomiting, generalized headache and neck stiffness for two days prior to admission. Lumbar puncture yielded a turbid CSF with 1360 WBCs (88% seg) and 210 RBCs, 73 glucose and 191 protein. The patient was treated initially with IV antibiotics for possible bacterial meningitis until her CSF culture came negative. She was feeling slightly better with improvement in her headache until the 5th day of admission when she developed acute onset of bitemporal visual field defects. MRI of the head revealed a suprasellar mass. The patient underwent a left frontal craniotomy with subtotal removal of the mass. Pathology later showed an acute hemorrhagic infarction of a pituitary adenoma.
Conclusion: Pituitary apoplexy should be considered in the differential diagnosis of "aseptic meningitis".
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
