case_images: PMC5228684_01
case_images: The pituitary microadenoma (arrow) is shown in a sagittal T1-weighted gadolinium contrast-enhanced MRI (A); A coronal, T2-weighted brain magnetic resonance image depicts focal encephalomalacia in the left frontal lobe (arrow head) (B). MRI = magnetic resonance imaging.
case_images: medi-96-e5774-g001.jpg
case_images: PMC5228684_01_medi-96-e5774-g001.jpg
case_images: F1
case_images: A 31-year-old woman with a 3-year history of amenorrhea and galactorrhea was referred to our neurosurgery outpatient department (OPD) 1 year earlier, following a diagnosis of a pituitary microadenoma (Fig. 1A). In addition to pituiyary microadenoma, magnetic resonance imaging (MRI) of pre-operation also revealed focal encephalomalacia in the left frontal lobe (Fig. 1B) that was thought to be due to her previous head injury.
case_images: Multiple cerebral infarctions are evident in (A) a diffusion-weighted image, (B) an apparent diffusion coefficient map; brain CT scan showing progressive edema on postoperative days 4 (C) and 7 (D). CT = computed tomography.
case_images: medi-96-e5774-g002.jpg
case_images: PMC5228684_01_medi-96-e5774-g002.jpg
case_images: F2
case_images: Brain computed tomography (CT) showed hypodensities in the bilateral frontal lobes, left temporal lobe, and left basal ganglion with severe swelling of the right frontal lobe which compressed right lateral ventricle (Fig. 2C). To determinate the extend of infarction area, the urgent brain MRI was performed which confirmed multiple acute lacunar infarcts in the bilateral frontal lobes, left parietal lobe, left occipital lobe, bilateral basal ganglia, and left thalamus (Fig. 2A and B). Acinetobacter baumannii). Although plasma exchange, corticosteroids, anticoagulant agent, and empiric antibiotic treatment were administered under impression of fatal type of APS, deep coma (Glasgow Coma Scale score E1M1VT) with central failure still occurred at postoperative day 9 while repeat CT scan of brain revealed profound infarctions and diffuse brain swelling (Fig. 2D).