life-threatening emergency characterized with acute pituitary hemorrhage that lead to clinical cranial nerve deficiency

Presentation

• WorstHeadache in their life

• Hypotension ↓(<90/60)

• Hypoglycemia ↓( ≤ 4)

• Hyponatremia ↓ [Na] (<135)

• Hypo-functionality

• Effect on cranial nerves

  • CN II
    • RAPD
    • Decreased red perception
    • Blurry Vision → Snellen chart (Visual Acuity)
    • Pale optic disc →Fundoscope
    • Bitemporal hemianopsia
  • CN III, IV, VI
    • BinocularDiplopia → H test - EOM
  • CN V1, V2
    • Facial Numbness → Sensory Exam

• Risk Factors

  • Pre-existing pituitary macroadenoma PIT-NET
  • Post-partum Complications (“Sheehan’s syndrome”)

Treatment

• hemodynamic support → ABCs (primary survey) stabalization
• replace deficient hormones,
  • IV Hydrocortisone to treat hypoglycemia and hyponatremia
• Surgery is done when there is visual loss (Cranial nerve II is affected).