Case of an isolated oculomotor nerve damage caused by pituitary hemorrhage without cavernous sinus invasion
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Neurology and Neurosurgery Department, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Tomasz Matyskieła   

Neurology and Neurosurgery Department, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland. Tel.: +48 89 524 53 47.
Submission date: 2015-02-11
Acceptance date: 2015-12-08
Online publication date: 2016-01-27
Publication date: 2020-03-23
Pol. Ann. Med. 2016;23(1):46–48
Pituitary apoplexy is a rare endocrine emergency. The term refers to an acute ischemia or hemorrhage into the gland, most often on the basis of preexisting adenoma. The clinical symptoms include a sudden headache, nausea, vomiting, ophthalmic symptoms and hormonal dysfunction. The most severe, life threatening complication of pituitary apoplexy is adrenal insufficiency. The patient may complain of vision disturbances preceded by headaches localized behind the eye. This reflects pressure toward optic nerve caused by expanding mass. When it invades cavernous sinus, it can reach and damage the 3rd, 4th, 5th and 6th cranial nerve. Focal brain ischemia may occur due to direct pressure on internal carotid artery or vasospasm in reaction to local factors.

To present an example of a clinical evaluation of the patient with an isolated oculomotor nerve damage and comorbidities like diabetes which alone may account for ischemic nerve damage.

Case study:
We present a case report of a patient suffering from pituitary apoplexy without cavernous sinus involvement and an isolated oculomotor nerve damage.

Results and discussion:
We revise literature on pathophysiology of the third cranial nerve damage in the setting of pituitary apoplexy and make an attempt to explain constellation of the symptoms in our patient.

Pituitary apoplexy should be taken into consideration during a sudden isolated oculomotor nerve palsy. Immediate transsphenoidal pituitary decompression is a potentially effective method of the treatment. In the setting of a little expanding lesion an oculomotor nerve function may be restored without any surgical intervention.

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