Simulated pituitary apoplexy: report of an unusual case due to hemorrhage into hypothalamic astrocytoma.

An unusual case of acute bilateral loss of vision simulating pituitary apoplexy but due instead to a fatal hemorrhage into a hypothalamic glioma is reported. The clinician dealing with abrupt loss of vision must promptly rule out ocular and orbital causes and then proceed immediately to a consideration of the variety of intracranial lesions which may cause sudden visual loss. Uihlein and Rucker have listed them in descending order of frequency: pituitary adenoma, tumors of the optic nerve and chiasm, supraclinoid aneurysm, parasellar lesion, thrombosis of the carotid artery, hydrocephalus of the third ventricle, chiasmal arachnoiditis, fracture of the anterior cranial fossa, basofrontal tumor of the skull, and pseudotumor cerebri. Neurologic, ophthalmologic, and neuroradiologic evaluations should be obtained without delay and will usually define the lesion and point to the appropriate treatment.