Chiasmal Syndromes

A 50-year-old right-handed woman with no significant past medical history underwent liposuction on her abdomen, hips, and thighs under general anesthesia. Her height and weight were 167 cm and 63 kg, respectively. Subcutaneous fat was injected with 2.5 L of 0.05% xylocaine and 1:10,000,000 epinephrine in lactated Ringer's solution prior to liposuction. Upon awakening, she complained of intense headache and was unable to open her right eye. Headache persisted, and she had nausea and vomiting the same day. She saw an ophthalmologist 2 days later, who observed palsy of right cranial nerves III, IV, and VI. An MRI the next morning showed a 2.7 x 2.7 x 3.2 cm intrasellar mass with erosion of the floor and elevation and compression of the optic nerves and chiasm. No enhancement was noted. The mass had a hyperintense rim of T1 suggestive of methemoglobin. There was a signal void on T2. A four-vessel cerebral angiogram ruled out aneurysm. The diagnosis was pituitary apoplexy. Pair with 97_65, 97_66, and 97_68.