Pituitary Apoplexy Presenting as Isolated Third Cranial Nerve Palsy with Ptosis : Two Case Reports.
10.3340/jkns.2009.45.2.118
- Author:
Won Jin CHO
1
;
Sung Pil JOO
;
Tae Sun KIM
;
Bo Ra SEO
Author Information
1. Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea. nsjsp@hanmail.net
- Publication Type:Case Report
- Keywords:
Third cranial nerve palsy;
Ptosis;
Pituitary apoplexy
- MeSH:
Brain;
Cavernous Sinus;
Decompression;
Diagnosis, Differential;
Diplopia;
Displacement (Psychology);
Floors and Floorcoverings;
Hemorrhage;
Humans;
Hypopituitarism;
Infarction;
Magnetic Resonance Imaging;
Oculomotor Nerve;
Optic Chiasm;
Paralysis;
Pituitary Apoplexy;
Pituitary Gland;
Pituitary Neoplasms;
Postoperative Period
- From:Journal of Korean Neurosurgical Society
2009;45(2):118-121
- CountryRepublic of Korea
- Language:English
-
Abstract:
Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a pituitary adenoma or an adjacent pituitary gland. Pituitary apoplexy may be associated with a variety of neurological and endocrinological signs and symptoms. However, isolated third cranial nerve palsy with ptosis as the presenting sign of pituitary apoplexy is very rare. We describe two cases of pituitary apoplexy presenting as sudden-onset unilateral ptosis and diplopia. In one case, brain magnetic resonance imaging (MRI) revealed a mass in the pituitary fossa with signs of hemorrhage, upward displacement of the optic chiasm, erosion of the sellar floor and invasion of the right cavernous sinus. In the other case, MRI showed a large area of insufficient enhancement in the anterior pituitary consistent with pituitary infarction or Sheehan's syndrome. We performed neurosurgical decompression via a transsphenoidal approach. Both patients showed an uneventful recovery. Both cases of isolated third cranial nerve palsy with ptosis completely resolved during the early postoperative period. We suggest that pituitary apoplexy should be included in the differential diagnosis of patients presenting with isolated third cranial nerve palsy with ptosis and that prompt neurosurgical decompression should be considered for the preservation of third cranial nerve function.
