PMC4575713_01
(a) Magnetic resonance showing the pituitary adenoma. (b) Magnetic resonance showing the ischemic lesion on the right side. (c) Digital subtraction angiography (DSA) showing the occlusion of the internal carotid artery at the level of the cavernous sinus on the right side. (d) Perfusion weighted CT scan: prolonged mean transit time on the right hemisphere. ((e) and (f)) Postoperative DSA (lateral view) showing the functioning of the bypass, early and late arterial phase.
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He underwent MR of the head that found a small area of restricted diffusion on the right side consistent with acute ischemia, intracranial ICA occlusion on the right side, and a large mass that filled the sella turcica and extended superiorly (Figures 1(a) and 1(b)). A digital subtraction angiography (DSA) confirmed the complete occlusion of the ICA on the right side with unsatisfactory compensations (Figure 1(c)). A perfusion weighted CT (pCT) scan showed a condition of hypoperfusion as suggested by a prolonged mean transit time (Figure 1(d)) and a pathological response to the Diamox stress test on the right side. DSA demonstrated the functioning of the bypass (Figures 1(e) and 1(f)) and then the patient was operated on to remove the pituitary tumor through a transsphenoidal approach.