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A 38 year-old woman developed a severe and sudden headache followed by double vision and then loss of vision.
(Left) T1-weighed axial image; (Right) Sagittal T1-weighted image. First, note the enlargement of the pituitary gland (arrows). Within the gland is a bright signal - this is subacute blood. Pituitary apoplexy is characterized by sudden onset of headache, visual symptoms, altered mental status, and hormonal dysfunction due to acute hemorrhage or infarction of a pituitary gland. There is usually an existing pituitary adenoma present. The visual symptoms may include visual acuity and visual field impairment from involvement of the optic nerve or chiasm and ocular motility dysfunction from involvement of the cranial nerves traversing the cavernous sinus. The headache may mimic that of subarachnoid hemorrhage. Pituitary apoplexy is a medical emergency, requiring urgent replacement of corticosteroids.
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