Apoplexy is an ancient medical word that originated in Greece — by definition, a term for internal organ bleeding. Beginning in the late 14th century, physicians often used the word to describe a loss of consciousness, followed by sudden death. Although it still appeared in the International List of Causes of Death in 1929, its use as an official diagnosis was becoming increasingly rare. Today, health professionals combine the term with the location of the bleeding, resulting in conditions such as pituitary apoplexy, ovarian apoplexy, and cerebral apoplexy.

The Evolution of “Apoplexy”

In Ancient Greece, physicians diagnosed patients “struck down with violence,” who stopped breathing and had no pulse, as having apoplexy. They believed the gods had literally struck the individual down. Hippocrates was the first to record the term, which he documented in several areas throughout his work. He describes the condition as head pain, a loss of speech, and incapacitation followed by death in what was an otherwise healthy person. Today, doctors connect these symptoms with a cerebrovascular accident or a stroke; “plex” is the Greek term for a stroke. Over time, as the field of medicine evolved, so did the terms used to describe specific conditions. Medical science divided the term apoplexy into categories based on the cause.

Cerebral Apoplexy (Stroke)

Bleeding in the brain or a blockage in one of the blood vessels in the brain causes cerebral apoplexy. Doctors call this a stroke or brain attack. It occurs when a lack of blood supply causes part of the brain to die. There are different types of strokes:

• A blood clot that blocks blood flow to the brain causes an ischemic stroke.
• A transient ischemic stroke or mini-stroke occurs when a temporary clot interrupts blood flow.
• A hemorrhagic stroke happens when a blood vessel in the brain bursts and bleeds. An aneurysm is one type of hemorrhagic stroke. More rarely, an arteriovenous malformation, an abnormal mass of blood vessels, forms in the brain. If one of the vessels bursts, it causes a brain bleed.

Symptoms of a Stroke

Individuals usually experience a series of symptoms before a stroke. They may have a severe headache or feel dizzy. Numbness in the face, arm, and leg often occurs on one side of the body. Some people report a loss of vision in one eye, on either side. Others describe the double vision. Because a stroke affects the brain, the person may also have difficulty speaking or understanding speech. If the individual seeks immediate care after experiencing the signs, medical professionals can prevent an actual stroke.

Pituitary Apoplexy

Apoplexy describes larger bleeds or hemorrhages that lead to a sudden onset of symptoms. Pituitary apoplexy or pituitary hemorrhage can occur with pituitary tumors but is more common with macroadenomas, which are large tumors. If the tumor suddenly increases in size, it is most likely compressing the pituitary gland, optic nerves, and the nerves that control eye movements. These symptoms usually indicate pituitary apoplexy. If the physician diagnoses and treats the condition promptly, it is not life-threatening.

Signs of Pituitary Apoplexy

Not all people experience the same symptoms of pituitary apoplexy.

• If the individual with a pituitary tumor complains of a sudden headache, stiff neck, fever, or nausea, this could indicate bleeding has affected the cerebrospinal fluid spaces.
• Vision loss, diminished outer peripheral vision, double vision, or complete blindness may occur.
• Pituitary failure may lead to a loss of body and facial hair. Men may experience reduced sex hormone production and low testosterone levels, which lead to impotence or reduced sex drive. Women may experience infertility.
• Elevated prolactin levels may trigger a loss of menstrual periods and cause breast milk production even if the woman is not pregnant or breastfeeding.
• Low cortisol levels affect appetite, weight, energy levels, and mental function.
• Those who experience changes in hormone function may also experience an electrolyte imbalance and low sodium levels leading to seizures and severe fatigue.

Ovarian Apoplexy

If a female’s ovary ruptures and she experiences a hemorrhage in the ovarian tissues or bleeding in the intraperitoneal space in the abdominal cavity, she has ovarian apoplexy. These ruptures usually occur as a result of a cyst on the ovary. An ovarian cyst is generally harmless and goes away without medical intervention, but some cysts tend to grow much larger and are more likely to rupture. Certain conditions, such as polycystic ovary syndrome or medications that increase ovulation, may cause the ovary’s blood vessels to contract and dilate, which may lead to a hemorrhage.

Symptoms of Ovarian Apoplexy

Intense physical activity and sexual intercourse can cause ovarian apoplexy. Symptoms include pain in the lower abdomen, usually following a delay in menstruation or mid-cycle bleeding. Some females report radiating pain that extends from the lower abdomen to the lumbar or umbilical areas or the rectum. Vaginal bleeding may also occur. If the person is also experiencing low blood pressure, an increase in heart rate, dizziness, chills, vomiting, and fever, a doctor may suspect ovarian apoplexy.

Adrenal Apoplexy

Bleeding into the adrenal glands describes a rare condition called adrenal apoplexy. The adrenal glands are two triangular-shaped, thumb-sized glands located at the top of each kidney. More commonly called an adrenal hemorrhage, this condition occurs as a result of traumatic injury. Anticoagulation therapy, blood disorders, sepsis, surgical stress, or hypotension causes bilateral adrenal hemorrhage, which occurs on both sides. A one-sided hemorrhage is unilateral. Experts generally associate this response with a blunt trauma injury to the abdomen. Individuals who have undergone liver transplants or have received a diagnosis for adrenal tumors may also develop the condition.

Signs of Adrenal Apoplexy

The first sign of adrenal apoplexy is acute abdominal pain. Additional symptoms include chest pain, vomiting, fever, hypotension, and an altered mental status. The individual may show a sudden drop in hematocrit, the ratio of red blood cells to total blood volume. Because adrenal apoplexy is such an obscure diagnosis, doctors may not recognize its symptoms. Diagnostic imaging generally uncovers signs of unilateral adrenal hemorrhage. Bilateral adrenal hemorrhage, often caused by sepsis, may result in coma or death if not promptly treated.

Apoplexy and Frustration

The contemporary definition of apoplexy has less to do with medical conditions and more to do with a state of emotion. Historically, the word described intense frustration. In the past, scientists and physicians believed that tension in the arteries caused apoplexy. Today, people use the term “apoplexy” to describe individuals in a state of near-uncontrollable anger. Through centuries of research and observation, physicians and scientists learned that a state of emotional apoplexy does not cause a person to bleed internally.