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Pituitary apoplexy — SCE Neurology MCQ

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ModerateHeadachePituitary apoplexySCE Neurology

A 63-year-old woman presented with sudden severe headache, vomiting and diplopia in known pituitary macroadenoma. On examination, there was bitemporal hemianopia and third nerve palsy. Initial investigations showed: MRI showed haemorrhage within the pituitary tumour. Where is the most likely anatomical localisation?

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Correct answer: E — sella turcica and cavernous sinus

sella turcica and cavernous sinus is the best answer because the vignette describes Pituitary apoplexy: acute headache with visual field loss and ophthalmoplegia indicates pituitary apoplexy. Peripheral nerve roots is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Periventricular white matter and Thoracic spinal cord are less appropriate because they would require different localisation, timing or test findings; Contralateral internal capsule would fit a different syndrome. Clinical pearl: SAH causes meningism but not bitemporal field loss from sellar expansion.

Reference: NICE CG150; BASH headache guidance; BNF