Isolated Oculomotor Nerve Palsy in Patients with Pituitary Apoplexy

• Roopa Rokhade,*  
• Pradeep Kumar Jain

Abstract

Pituitary apoplexy (PA) is a neurosurgical emergency caused by a sudden hemorrhage or infarction within the pituitary adenoma. The classic clinical presentations of PA include acute headaches and visual disturbances. However, isolated third cranial nerve palsy with ptosis as the initial manifestation of pituitary apoplexy is extremely rare. We describe three cases of pituitary apoplexy presenting with isolated third cranial nerve palsy. One patient had bilateral isolated oculomotor nerve palsy, while another had pupil-sparing oculomotor nerve palsy, which is more common in ischemic than compressive etiology. Our patients recovered completely following an early neurosurgical intervention. Two patients underwent transnasal surgery, and one had a transcranial procedure. After surgery, all patients recovered well. PA should thus be considered in the differential diagnosis of patients presenting with isolated third nerve palsy.

Keywords

pituitary apoplexy, diplopia, third cranial nerve palsy, oculomotor nerve palsy, ptosis