Cerebrovascular manifestations of pheochromocytoma and the implications of a missed diagnosis.

BACKGROUND AND PURPOSE: Cerebrovascular complications are a rare manifestation of pheochromocytoma. We report a case of pheochromocytoma presenting initially with reversible posterior leukoencephalopathy and subsequently a cerebral infarction. A patient with a prior history of episodic hypertension and reversible posterior leukoencephalopathy presented with headache, palpitations, and weakness of the right leg. A magnetic resonance angiogram revealed narrowing of the basilar and right middle cerebral artery. She was diagnosed as having presumed vasculitis and underwent a conventional cerebral angiogram during which she developed a hypertensive crisis and worsening neurological deficit. Further investigations revealed the presence of a pheochromocytoma, which was subsequently resected.

CONCLUSIONS

It is important to be cognizant of the possibility of pheochromocytoma in patients presenting with hypertension and cerebrovascular manifestations, as commonly used investigations (e.g. catheter angiography) and treatment modalities (e.g. beta-blockers to treat hypertension, corticosteroids to treat suspected vasculitis, etc.) can lead to life threatening complications.