Abstract
Case series of pituitary apoplexy presenting as isolated oculomotor nerve palsy and a review of literature with possible insight into underlying pathophysiology.
Highlights
The first case of pituitary tumour haemorrhage was described by Pearce Bailey in 1898 [1], but the first full description was published in 1950 by Brougham et al, using the term “pituitary apoplexy” [3]
Pituitary apoplexy is a potentially fatal medical condition characterized by a sudden onset of headache, visual symptoms, altered mental status, and hormonal dysfunction due to acute haemorrhage, and/or necrosis or infarction of a pituitary gland [2,4,5]
Most series indicate that the incidence of apoplexy in pituitary adenomas is between 2 % and 7 % when defined based on clinical signs with surgical or histopathological evidence [2, 20,21,22]
Summary
The first case of pituitary tumour haemorrhage was described by Pearce Bailey in 1898 [1], but the first full description was published in 1950 by Brougham et al, using the term “pituitary apoplexy” [3]. We recorded 5 cases of pituitary apoplexy presenting as isolated third cranial nerve palsy between 2015 and 2019 from three neurosurgical institutions in Singapore. Based on the presence of the left third cranial nerve palsy and headache, angiogram (Figure 2) did not demonstrate an aneurysm but showed a our initial concern was an expanding aneurysm of the posterior dumbbell-shaped seller mass with suprasellar extension, measuring communicating artery. The mass abuts the optic chiasm, with likely optic developed diabetes insipidus during this period and was commenced neuropathy involving the optic chiasm and both optic nerves as well on oral desmopressin 50mcg daily He was started on intravenous as Knosp 1 left cavernous sinus extension (Figure 3). Months diplopia pituitary macroadenoma sphenoidal resection recovery displacing optic chiasm superiorly
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