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Pituitary apoplexy complicated by internal carotid artery occlusion was encountered in a patient with surprisingly moderate symptoms at presentation. For a short period of watchful waiting, primary collaterals obscured the emergent need for decompressive surgery, which after the sudden onset of neurological deterioration fortunately salvaged imminent cerebral infarction. Although a few similar cases have been described previously, the importance of collateral circulation has been left virtually without comment, while contrasting treatment strategies and high mortality rates suggest further case reports are warranted. Notably, a symptoms-based management seems likely to be insufficient in these rare situations, while our experience indicate early surgery could be judicious to consider.  Keywords: Pituitary apoplexy; Internal carotid artery occlusion; Collateral circulation.

A rare case of pituitary apoplexy complicated by internal carotid artery occlusion: Severity obscured by primary collaterals