Introduction: Pituitary apoplexy is a rare, life-threatening condition resulting from hemorrhage or infarction of the pituitary gland, most commonly in patients with pre-existing pituitary tumors. It typically presents with a sudden headache, visual disturbance, ophthalmoplegia, and altered mental status. An uncommon but serious complication is ischemic stroke in the middle cerebral artery (MCA) territory, particularly in the absence of direct internal carotid artery (ICA) compression. Case: We report a case of a 36-year-old male who presented with headache, visual impairment, and fever. Initial computed tomography (CT) brain imaging demonstrated a heterogeneous sellar lesion with peripheral calcification measuring 2.4 × 3.2 × 2.7 cm, suggestive of a pituitary mass with possible apoplexy, without evidence of acute cerebral infarction. The patient subsequently developed dysarthria, hemianopia, and reduced consciousness, prompting repeat neuroimaging. Follow-up CT revealed a large hypodense area in the right fronto-parieto-temporal region consistent with ischemic infarction. Magnetic resonance imaging confirmed an acute infarct in the right MCA territory without hemorrhagic transformation. A sellar-suprasellar mass measuring 2.3 × 2.8 × 3.8 cm was identified, consistent with a pituitary macroadenoma with intratumoral hemorrhage compressing the optic chiasm, but without direct right ICA compression. Time-of-flight mineralocorticoid receptor antagonists demonstrated attenuated flow in the right ICA (C2–C7), suggesting intracranial ICA thrombosis and reduced perfusion in the right MCA and its branches. Laboratory evaluation revealed hyperthyroidism and hypocortisolism, with no evidence of coagulopathy. The patient was treated with corticosteroid replacement and carbimazole and referred for neurosurgical management. Conclusion This case highlights a rare association between pituitary apoplexy and MCA stroke, possibly mediated by vasospasm, inflammation, or hypercoagulability. More research is needed to understand this connection and improve treatment strategies.
Middle Cerebral Artery ; Pituitary Apoplexy ; Infarction

Introduction: This study explored stroke survivors’ understanding regarding stroke, the perceived facilitators and barriers of healthy lifestyle changes, and provision of secondary prevention education. Methods: Semi-structured interviews were conducted with 22 stroke patients (13 males and nine females; aged 34-80 years) who were attending rehabilitation clinics in three Malaysian hospitals. Each interview was audiotaped, transcribed, and analysed using the framework approach. Results: Six themes were reported: understanding of stroke; facilitators of healthy lifestyle changes; barriers of healthy lifestyle changes; food taboos; recovery; and provision of secondary stroke prevention. A third of them were uncertain about the cause of stroke and the perception towards risk of recurrent stroke varied widely. The lack of secondary prevention education was obvious although many had received general verbal advices. Several personal, social, and environmental factors were identified as the facilitators or barriers in healthy lifestyle participation. Food taboos were common and had become one of the barriers in practising healthy eating practices. Families had a strong influence on the patient’s belief and behaviour changes, both in positive and negative ways. Besides, patients tended to have a problem in information recall, while some faced confusion during the early stages of stroke recovery. Conclusion: More efforts to improve knowledge regarding cause of stroke and secondary prevention strategies are needed. Use of appropriate behavioural changes strategies, family-centred approach and continuous health education are necessary to facilitate patients’ efforts at making successful lifestyle modification after stroke event.

No abstract available.
Diffusion Tensor Imaging ; Diffusion ; Hemiplegia ; Humans