Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Open Access policy
Abstracting & indexing
Affiliated institutions
Contact
Instructions
Peer review process
Guide for authors
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Reviewers
Guide for reviewers
List of reviewers
Review Form
CASE REPORT
Case of an isolated oculomotor nerve damage caused by pituitary hemorrhage without cavernous sinus invasion
| 1 | Neurology and Neurosurgery Department, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland |
CORRESPONDING AUTHOR
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.
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
KEYWORDS
ABSTRACT
Introduction:
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.
Aim:
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.
Conclusions:
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.
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.
Aim:
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.
Conclusions:
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.
REFERENCES (18)
1.
Ranabir S, Baruah MP. Pituitary apoplexy. Indian J Endocrinol Metabol. 2011;15(7):188–196.
2.
Nawar RN, Abdel-Mannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. Intensive Care Med. 2008;23(2):75–90.
3.
Enatsu R, Asahi M, Matsumoto M, Hirai O. Pituitary apoplexy presenting atypical time course of ophthalmic symptoms. Tohoku J Exp Med. 2012;227(1):59–61.
4.
Conomy JP, Ferguson JH, Brodkey JS, Mitsumoto H. Spontaneous infarction in pituitary tumors: neurologic and therapeutic aspects. Neurology. 1975;25(6):580–587.
5.
Ahmed SK, Semple PL. Cerebral ischaemia in pituitary apoplexy. Acta Neurochir. 2008;150(11):1193–1196.
6.
Han F, Peng B, Gao S, Mao CH, Cui LY, Xing B, Zhu YC. Clinical reasoning: a 42-year-old man with severe headache, fever, and acute coma. Neurology. 2014;82(2):e9–e13.
7.
Bjerre P, Gyldensted C, Riishede J, Lindholm J. The empty sella and pituitary adenomas. A theory on the causal relationship. Acta Neurol Scand. 1982;66(1):82–92.
8.
Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery. 1984;14(3):363–373.
9.
Möller-Goede DL, Brändle M, Landau K, Bernays RL, Schmid C. Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol. 2011;164(1):37–43.
10.
Cho W-J, Joo S-P, Kim T-S, Seo B-R. Pituitary apoplexy presenting as isolated third cranial nerve palsy with ptosis: two case reports. J Korean Neurosurg Soc. 2009;45(2):118–121.
11.
Kobayashi H, Kawabori M, Terasaka S, Murata J, Houkin K. A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases. Acta Neurochir (Wien). 2011;153(12):2453–2456.
12.
Umansky F, Valarezo A, Elidan J. The superior wall of the cavernous sinus: a microanatomical study. Neurosurgery. 1994;81(6):914–920.
13.
Parkinson D. Surgical anatomy of the cavernous sinus. In: Wilkins RH, Rengachary SS, eds. In: Neurosurgery. New York: McGraw Hill; 1985:1478–1483.
14.
Kim SH, Lee KC, Kim SH. Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci. 2007;14(12):1158–1162.
15.
Bansal S, Mandal K, Kamal A. Painful vertical diplopia as a presentation of a pituitary mass. BMC Ophthalmol. 2007;7:4.
16.
Saul RF, Hilliker JK. Third nerve palsy: the presenting sign of a pituitary adenoma in five patients and the only neurological sign in four patients. Clin Neuroophthalmol. 1985;5:185–193.
17.
Chuang CC, Chen E, Huang YC, Tu PH, Chen YL, Pai PC. Surgical outcome of oculomotor nerve palsy in pituitary adenoma. J Clin Neurosci. 2011;18(11):1463–1468.
18.
Diyora B, Nayak N, Kukreja S, Kamble H. Sudden onset isolated complete third nerve palsy due to a pituitary apoplexy. Oman J Ophthalmol. 2011;4(1):32–34.
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.