术后，患者视野和视敏度恢复至基线（图3）。热退，CRP降低。ECG回复正常。心脏检查，包括运动负荷试验和心肌灌注扫描，未见缺血性心脏病迹象，表明术前注意到的球面ST段凹陷为垂体卒中所致。患者出院回家，继续氢化可的松和甲状腺素替代疗法。
讨论 今描述一例垂体卒中患者，该患者已知罹患垂体腺瘤，并接受急性冠脉综合征治疗。根据现代急性冠脉治疗方案，施以抗凝鸡尾酒治疗，组方为阿司匹林、肝素和氯吡格雷。阿司匹林、肝素加氯吡格雷已经证实可减少阿司匹林、肝素单用所引起的后续心血管事件发生率。然而，这也造成了大出血率（主要是胃肠道）的明显上升（由2.7%上升到3.7%）[12]。卒中危象初始症状为发热、头痛、恶心和呕吐症状，ECG ST段压低，蛛网膜下出血时曾报告此结果[13]，但以前并未报告与垂体卒中有关。卒中发生时，严重视力丧失或死亡风险很大，特别是在因非典型性症状，如不明因发热、低钠血症和意识障碍等，导致诊断延误的情况下[6]。一些非诊断性检查，如CSF[14]非特异性变化或脑部CT扫描表面正常等，可加重这一情况。现已证明，与MRI扫描相比，这些非诊断性检查对检测垂体卒中的敏感性较低。
结论 众所周知，抗凝作用是垂体卒中的诱发因素。与本例患者一样，另有一则病例研究报告一例由阿司匹林、氯吡格雷和依诺肝素诱发垂体卒中的患者，虽然该例患者此前并不知道有垂体腺瘤[16]。因此，本病例使以下操作要点显得尤为重要：在已知患有垂体腺瘤的患者中，这种情况应被视作是抗凝作用的相对禁忌症。应警告这些患者，在治疗其垂体腺瘤时注意潜在的抗凝风险。如果这些患者出现抗凝作用，一旦患者急性病倒，临床医师就应高度怀疑垂体卒中：尽早开始氢化可的松替代疗法。(来源：
Journal of Medical Case Reports 2007, 1:74 )
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