A case with pituitary apoplexy presenting with isolated oculomotor nerve palsy: Case report and literature review

Abstract

Isolated oculomotor nerve palsy with pupillary involvement is one of the rare symptoms of pituitary adenoma and may be associated with either pituitary macroadenoma or pituitary apoplexy. Pituitary (hypophyseal) apoplexy is a rare emergency resulting from an acute hemorrhage or infarction of pituitary gland or adenoma. Clinical manifestations consist of severe headache of sudden onset, visual loss and hypopituitarism. Although isolated oculomotor nerve palsy may be observed, other structures within the cavernous sinuses that lay adjacent to the pituitary gland, including trochlear and abduscence nerves, first and second branches of the trigeminal nerve and sympathetic nerves may also be affected and accompany oculomotor nerve palsy. A 72 year-old male patient with pituitary apoplexy related to a previously unknown pituitary macroadenoma, who was diagnosed after developing a painful, isolated, pupil involved oculomotor nerve palsy was presented in this case presentation. This case deserves to be presented, to point out pituitary apoplexy as a rare cause in the differential diagnosis of acute painful oculomotor nerve palsy with pupillary involvement.

Pituitary Apoplexy: An Emergent and Potential Life-Threatening Complication of Pituitary Adenomas

“…[ 14 ] They presented with headache, visual impairment, cranial nerve dysfunctions or hormonal abnormalities according to their mass effect. [ 9 , 15 ] Pituitary apoplexy is a clinical condition secondary to expansion of the intrasellar contents because of an infarction and/or hemorrhage in the tumor. In 25% of cases, pituitary apoplexy develops secondary to a pituitary adenoma.…”

“…Sudden onset with ophthalmoplegia and visual disturbances usually require emergent surgical intervention. [ 3 , 5 , 9 ] Today, endoscopic techniques are state-of-art options for surgical treatment. Endoscopic endonasal transsphenoidal (EET) technique provides quick and safe clinical and radiological improvement.…”