Pituitary Apoplexy Mimicking Bacterial Meningitis with Intracranial Hypertension

CASE DESCRIPTION: A 29-year-old patient experienced a violent headache during bodybuilding exercises. Brain magnetic resonance imaging revealed diffuse meningitis and a 38-mm necrotic pituitary adenoma. Meningoencephalitis was suspected but was ruled out by lumbar puncture. Rapid deterioration of the patient's condition led to coma and oxygen desaturation secondary to intracranial hypertension. Intense treatment for intracranial hypertension included profound sedation with respiratory assistance, osmotherapy, hypothermia, and external ventricular drainage. After 4 weeks in the intensive care unit, the patient fully recovered and was discharged with hormonal supplementation. CONCLUSIONS: The few reported cases of pituitary apoplexy mimicking bacterial meningoencephalitis may have resulted from blood leakage or necrosis into the subarachnoid space.