Rare coincidence of a giant aneurysm of the basilar artery with a macroadenoma of the pituitary gland in a forensic autopsy

Based on a recent case, the combined occurrence of a giant aneurysm in the transition zone of vertebral artery and basilar artery with a macroadenoma of the pituitary gland is reported. A 42-year-old man requiring dialysis because of terminal renal insufficiency due to glomerulonephritis and with the previous diagnoses of arterial hypertension and an untreated macroadenoma of the pituitary gland was admitted to hospital for neurological symptoms (hemiparesis, impaired speech and balance, dizziness). The diagnostic measures revealed an unruptured large aneurysm of the vertebral/basilar artery with cerebrospinal fluid block and signs of elevated intracranial pressure (internal obstructive hydrocephalus) as well as a macroadenoma of the pituitary gland. In view of the fact that the intracranial pressure was rising progressively and the aneurysm was categorized as inoperable, a ventriculoperitoneal shunt was placed. After normalization of the intracranial pressure and an uneventful postoperative course, the patient was transferred to a rehabilitation facility where he died unexpectedly 2 weeks later. As the circumstances of his death were unclear, a forensic autopsy was ordered, the results of which are reported and discussed.