1
|
Magdum R, Goli KB, Alapati A, Ganesh A, Kilari S. Pituitary Adenoma Masquerading as Diabetic Third Nerve Palsy. Cureus 2024; 16:e60037. [PMID: 38854255 PMCID: PMC11162646 DOI: 10.7759/cureus.60037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
A 46-year-old uncontrolled diabetic female visited the ophthalmology outpatient department with a sudden onset of drooping of the upper lid and restriction of movements in adduction, depression, and elevation in the right eye, suggestive of third nerve palsy. Initially, it was thought to be due to a vasculogenic cause due to uncontrolled diabetes, but visual fields revealed bitemporal hemianopia, characteristic of a pituitary adenoma. The diagnosis was confirmed by a CT scan. The patient then underwent a trans-nasal endoscopic removal of the pituitary macroadenoma, followed by a partial recovery of vision.
Collapse
Affiliation(s)
- Renu Magdum
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Kalpita B Goli
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Aparna Alapati
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Aditya Ganesh
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Sindhu Kilari
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| |
Collapse
|
2
|
Pagoada-Torres JD, Villalobos-Díaz R, Pineda-Centeno LM, Pesci-Eguia L, Gomez-Villegas T, Rivera-Montes H, Portocarrero-Ortiz LA. Bilateral Sixth Nerve Palsy: A Rare Presentation of Primary Hypophysitis. Cureus 2024; 16:e58850. [PMID: 38784347 PMCID: PMC11115475 DOI: 10.7759/cureus.58850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Cranial nerve palsy is common in pituitary disease and depends on the extension of the lesion into the cavernous sinuses. Bilateral cranial nerve palsy was described in pituitary adenomas with apoplexy and in only one case in hypophysitis. We present a case of a 32-year-old female manifesting with headache, diplopia, bilateral sixth nerve palsy, and hypopituitarism. Magnetic resonance imaging (MRI) revealed symmetric expansion of the pituitary gland, with bilateral cavernous sinus invasion and thickening of the pituitary stalk. Hypophysitis was suspected, and after treatment with IV methylprednisolone boluses, a decrease in the pituitary lesion was observed, with complete remission of sixth nerve palsy in the right eye and partial improvement in the left eye. In this case, we report an infrequent form of presentation of hypophysitis, and highlight that steroids are the first line of treatment.
Collapse
Affiliation(s)
- Josue D Pagoada-Torres
- Endocrinology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Rodolfo Villalobos-Díaz
- Neurosurgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Luz M Pineda-Centeno
- Neurology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Luis Pesci-Eguia
- Ophthalmology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Thamar Gomez-Villegas
- Ophthalmology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Hector Rivera-Montes
- Endocrinology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Lesly A Portocarrero-Ortiz
- Neuroendocrinology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| |
Collapse
|
3
|
Punia P, Patel A, Gotecha S, Lachake A, Shinde V, Chugh A. Pituitary Apoplexy Presenting with Isolated Third Nerve Palsy: A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1203-1207. [PMID: 38440546 PMCID: PMC10908972 DOI: 10.1007/s12070-023-04221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
A 46-year-old female came to neurosurgery outpatient department with sudden onset of drooping of RE upper eyelid and restriction of movements in adduction, depression and elevation in right eye. Patient was a known case of diabetes mellitus whose blood sugar levels were deranged. On examination, patient was diagnosed pituitary macroadenoma. Patient was treated for her uncontrolled diabetes mellitus following which she had underwent transsphenoidal pituitary macroadenoma removal. On treatment, patient's ptosis had subsided and restriction of movement has resolved.
Collapse
Affiliation(s)
- Prashant Punia
- Department of Neurosurgery, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- C1/604, Mahendra Antheia, Nehru Nagar Road, Pimpri, Pune, 411018 India
| | - Ankit Patel
- Department of Neurosurgery, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- C1/604, Mahendra Antheia, Nehru Nagar Road, Pimpri, Pune, 411018 India
| | - Sarang Gotecha
- Department of Neurosurgery, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- A2-203 Mahindra Antheia, Nehru Nagar, Pimpri, 411018 India
| | - Apurva Lachake
- Department of Neurosurgery, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- Flat A-204, Mahendra Royale, Nehru Nagar Road, Pimpri, Pune, 411018 India
- Department of Neurosurgery, Dr.D.Y.Patil Medical College, Hospital and Research Center, Sant Tukaram NagaR, Pimpri, Pune, India
| | - Vinod Shinde
- Department of ENT, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- DYPMCH, Sant Tukaram Nagar, Pimpri, Pune, 411018 India
| | - Ashish Chugh
- Department of Neurosurgery, Dr.D.Y.Patil Medical College and Hospital, Pimpri, Pune, Maharashtra India
- Sector 27, Plot No-415, Pradhikaran, Nigdi, Pune, 411044 India
| |
Collapse
|
4
|
Endoscopic Endonasal Skull Base Surgery Complication Avoidance: A Contemporary Review. Brain Sci 2022; 12:brainsci12121685. [PMID: 36552145 PMCID: PMC9776068 DOI: 10.3390/brainsci12121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
The endoscopic endonasal approach (EEA) provides a direct trajectory to ventral skull base lesions, avoidance of brain retraction, and clear visualization of cranial nerves as they exit skull base foramina. Despite these benefits, the EEA is not without complications. Here, we review published literature highlighting complications associated with the EEA including cerebrospinal fluid (CSF) leak, cranial nerve (CN) dysfunction, pituitary gland dysfunction, internal carotid artery (ICA) injury, infection, and others; we place special emphasis on discussing the prevention of these complications. As widespread adoption of the EEA continues, it becomes critical to educate surgeons regarding potential complications and their prevention while identifying gaps in the current literature to guide future research and advances in clinical care.
Collapse
|
5
|
Jeong DE, Kim DH. Analysis of Early Neuroimaging Results in Patients with Acute Isolated Ocular Motor Nerve Palsy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.10.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To evaluate the efficacy of early neuroimaging in patients with acute isolated 3rd, 4th, and 6th nerve palsy.Methods: Neuroimaging tests were performed in patients >50 years old with acute isolated 3rd, 4th, and 6th nerve palsy. The frequencies and types of abnormal findings were evaluated. All patients were divided into ischemic and non-ischemic groups and differences in clinical characteristics between groups were analyzed.Results: Of the 55 patients, nine (16.4%) had abnormal findings on brain imaging. Among 26 patients with 6th nerve palsy, four (15.4%) were found to have a cause including brain tumor, cerebrovascular compression, carotid cavernous fistula. Superior oblique muscle atrophy was found in two of 19 patients (10.5%) with 4th nerve palsy. Three of 10 patients (30%) with 3rd nerve palsy had abnormal findings and there were cases of pituitary apoplexy, posterior communicating, and cerebrovascular compression.Conclusions: In patients with acute isolated oculomotor paralysis, early neuroimaging tests play an important role in differential diagnosis and evaluation of causes that may lead to mortality.
Collapse
|
6
|
Yokoyama K, Ikeda N, Sugie A, Yamada M, Tanaka H, Ito Y, Kawanishi M. A Case of Nonapoplectic Pituitary Adenoma Presenting with Isolated Oculomotor Nerve Palsy. Asian J Neurosurg 2021; 16:391-393. [PMID: 34268172 PMCID: PMC8244716 DOI: 10.4103/ajns.ajns_397_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/25/2020] [Accepted: 03/28/2021] [Indexed: 12/03/2022] Open
Abstract
We report a rare case of nonapoplectic pituitary adenoma that did not invade the cavernous sinus and was associated with isolated oculomotor nerve palsy. A 61-year-old male was admitted to our hospital due to diplopia that had gradually worsened from 6 months to presentation. He was diagnosed with right oculomotor nerve palsy, and brain magnetic resonance imaging (MRI) showed a mass lesion within the sella. The tumor was homogeneously enhanced on contrast-enhanced MRI. However, no findings suggestive of pituitary apoplexy were found. Brain computed tomography revealed the tumor to have eroded the right side of the posterior clinoid process by gradual expansion. Endoscopic transsphenoidal surgery was used for complete resection of the tumor. Intraoperative findings showed that the tumor did not invade the cavernous sinus. The histological diagnosis was pituitary adenoma, and symptom improvement was observed from the early postoperative stage onward. Surgical treatment is essential because oculomotor nerve palsy caused by the enlargement of pituitary adenoma is not expected to resolve if treated conservatively, unlike that caused by pituitary apoplexy.
Collapse
Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan
| |
Collapse
|
7
|
Isolated bilateral abducens nerve palsy secondary to clivus metastasis of prostate adenocarcinoma undetected by magnetic resonance imaging. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
8
|
Mayà-Casalprim G, Serrano E, Oberoi H, Llull L. Paresia del nervio abducens bilateral aislada secundaria a metástasis en clivus de adenocarcinoma de próstata inadvertida en resonancia magnética. Neurologia 2020; 35:599-601. [DOI: 10.1016/j.nrl.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/27/2019] [Indexed: 11/27/2022] Open
|
9
|
Natarajan D, Tatineni S, Ponnapalli SP, Sachdeva V. Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes. BMJ Case Rep 2020; 13:13/6/e232490. [PMID: 32587114 DOI: 10.1136/bcr-2019-232490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of isolated unilateral complete pupil involving third cranial nerve palsy due to pituitary adenoma with parasellar extension into the right cavernous sinus. The patient was referred to us from neurosurgery with sudden onset binocular vertical diplopia with complete ptosis, and mild right-sided headache of 5-day duration. Ocular examination revealed pupil involving third cranial nerve palsy in right eye while rest of the examination including automated perimetry was normal. MRI brain with contrast revealed a mass lesion with heterogenous enhancement in the sella suggestive of a pituitary macroadenoma with possible internal haemorrhage (apoplexy). In addition, the MRI showed lateral spread to the right cavernous sinus which was causing compression of the right third cranial nerve. The patient was systemically stable. This report highlights a unique case as the lesion showed a lateral spread of pituitary adenoma without compression of the optic chiasm or other cranial nerves.
Collapse
Affiliation(s)
- Divya Natarajan
- Fellow Academy of Eye Care Education, Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Nimmagadda Prasad Children Eye Care Centre, LV Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| | - Suresh Tatineni
- Department of Neurosurgery, My Cure Hospital, Visakhapatnam, Andhra Pradesh, India
| | | | - Virender Sachdeva
- Child Sight Institute, Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Nimmagadda Prasad Children Eye Care Centre, LV Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
| |
Collapse
|
10
|
Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Belotti F, Zanin L, Fontanella MM, Panciani PP. The oculomotor neurovascular conflict: Literature review and proposal of management. Clin Neurol Neurosurg 2020; 195:105920. [PMID: 32474258 DOI: 10.1016/j.clineuro.2020.105920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Oculomotor nerve (OCN) lies in a close relationship with large arteries inside the basal cisterns. Therefore, it may be compressed by vascular malformations or aneurysms. Nevertheless, the compression is not always related to pathologic conditions. Indeed, some cases of neurovascular conflicts of the OCN have been described in the literature. METHODS A case of neurovascular conflict of the OCN resolved after steroid treatment is reported. Additionally, a systematic literature review of those cases was performed. RESULTS OCN palsy due to a neurovascular conflict has been described as acute or chronic persistent palsy, or with an intermittent presentation. Symptoms result from compression, although asymptomatic compression is not uncommon. Surgical treatment, pharmacological treatment, and observation have been reported as options in the literature. Microvascular decompression was employed effectively in some cases of OCN neurovascular conflict. Nevertheless, other cases were treated successfully with steroids (persistent presentation) and carbamazepine (intermittent presentation). A management algorithm based on the results of the literature review is proposed. CONCLUSIONS Treatment options for OCN neurovascular conflicts and their results are heterogeneous. Based on the literature review, the pharmacological treatment seems to be the most appropriate first-line approach, reserving surgery for refractory cases. Collecting clinical information about new cases will allow defining treatment standards for this rare condition.
Collapse
Affiliation(s)
- Francesco Belotti
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Luca Zanin
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Pier Paolo Panciani
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| |
Collapse
|
12
|
Heparin-Induced Pituitary Apoplexy Presenting as Isolated Unilateral Oculomotor Nerve Palsy: A Case Report and Literature Review. Case Rep Endocrinol 2019; 2019:5043925. [PMID: 31687223 PMCID: PMC6803741 DOI: 10.1155/2019/5043925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/25/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Pituitary apoplexy (PA) is a rare and potentially life-threatening clinical syndrome resulting from pituitary gland hemorrhage and/or infarction. Anticoagulation is a risk factor for triggering PA. Isolated oculomotor nerve palsy is an atypical presentation of PA. Case Presentation A 65-year-old African American female with no past medical history of pituitary disease presented to the emergency department (ED) with nonspecific abdominal pain that was thought to be secondary to fecal stasis and subsequently improved with laxatives. She also reported atypical chest pain that was concerning for unstable angina. She was started on aspirin, clopidogrel, and intravenous (IV) heparin. Later, coronary catheterization showed no significant coronary artery disease (CAD). Twelve hours after the procedure, the patient developed acute complete left oculomotor nerve palsy with a severe headache. Magnetic resonance imaging (MRI) of the head showed a large pituitary mass. Pituitary apoplexy was suspected and the patient eventually underwent a successful trans-sphenoidal pituitary resection. Discussion We report a case of PA manifesting as isolated left oculomotor nerve palsy without visual field defects in the setting of using dual antiplatelet therapy (DAPT) and IV heparin for acute coronary syndrome. To the best of our knowledge, this unique combination has not been previously reported.
Collapse
|
13
|
Cho H, Song YJ, Ryu WY. Pituitary Apoplexy Presenting as Isolated Bilateral Oculomotor Nerve Palsy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Heejung Cho
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Young Jin Song
- Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
| | - Won Yeol Ryu
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
14
|
Raza HK, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Mot Res 2018; 35:229-239. [PMID: 30592440 DOI: 10.1080/08990220.2018.1547697] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oculomotor nerve palsy (ONP) is an important and common clinical diagnosis. Its main features are diplopia and ptosis. Its aetiologies are various and complex. A number of different conditions have been reported to cause ONP, such as diabetes mellitus, aneurysm, tumours, painful ophthalmoplegia, pituitary lesions, cavernous sinus lesions, central nervous system infections, and subarachnoid haemorrhage. A patients needs to undergo several tests in order to establish the correct underlying pathology. In this review, we have summarized the aetiologies of the unilateral ONP, and discussed their relative clinical features, pathogenesis, diagnostic criteria, treatment options, and prognosis. We searched PubMed for papers related to ONP and its aetiologies, and selected the publications, which seemed appropriate.
Collapse
Affiliation(s)
- Hafiz Khuram Raza
- a School of International Education , Xuzhou Medical University , Xuzhou , China
| | - Hao Chen
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | | | - Guiyun Cui
- b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| |
Collapse
|
15
|
Wright HE, Brodsky MC, Chacko JG, Ramakrishnaiah RH, Phillips PH. Diplopia is better than no plopia! Surv Ophthalmol 2017; 62:875-881. [DOI: 10.1016/j.survophthal.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
|
16
|
Surgical Outcomes of Cavernous Sinus Syndrome in Pituitary Adenomas. World Neurosurg 2017; 107:526-533. [PMID: 28826864 DOI: 10.1016/j.wneu.2017.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The type of pituitary adenoma with a manifestation that includes cavernous sinus syndrome is rare. Based on the clinical data of 70 patients, this study investigated the pathogenesis, imaging characteristics, and prognostic factors of pituitary adenoma with cavernous sinus syndrome. METHODS We conducted a retrospective analysis of the characteristics of patients with pituitary adenoma with cavernous sinus syndrome who received surgical treatment. The patients were classified into different prognosis groups according to the time required for them to recover from the cavernous sinus syndrome. Univariate analyses were conducted for the correlations between the prognosis and factors. RESULTS Of the 3598 cases of pituitary adenomas, 70 (1.95%) presented cavernous sinus syndrome. Of the patients, 55.7% recovered within 2 weeks of surgery, 24.3% recovered from 2 weeks to 1 year after surgery, and 20% had not returned to normal after more than 1 year after surgery. Univariate analyses showed that shorter disease duration (P < 0.001), lower Knosp grade (P = 0.045), a transsphenoidal approach (P < 0.001), and associated pituitary apoplexy (P = 0.012) were predictive factors of early postoperative recovery. CONCLUSIONS The prognosis of cavernous sinus syndrome differs depending on the mechanism of the syndrome. There was no significant difference in the prognosis between patients with total pituitary adenoma resection and subtotal resection. Timely surgery within 100 days of symptom occurrence, Knosp grade 0-2, and associated pituitary apoplexy are predictive factors of good prognosis.
Collapse
|
17
|
Abouaf L, Vighetto A, Lebas M. Neuro-ophthalmologic exploration in non-functioning pituitary adenoma. ANNALES D'ENDOCRINOLOGIE 2015; 76:210-9. [PMID: 26070465 DOI: 10.1016/j.ando.2015.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 11/18/2022]
Abstract
Non-functioning pituitary adenoma may lead to blindness and causes visual impairment in 58% of cases and, more rarely, ocular motor disorder. Patients are slow to become aware of their visual dysfunction, vision in one eye compensating the deficit in the other. Assessment of visual function, comprising visual acuity and visual field evaluation and fundus examination, should be performed regularly according to the severity of impairment. Optic nerve optical coherence tomography (OCT) can quantify optic atrophy reproducibly, and is of prognostic value for postoperative visual recovery. Diplopia most often involves decompensation of heterophoria, visual field fusion being hampered by the visual field defect; such diplopia without ocular motor deficit is known as "hemifield slide". Diplopia associated with ocular motor palsy is caused by tumoral invasion of the cavernous sinus (IIIrd, IVth or VIth nerve palsy); in large impairment, restricted eye movement is easily observed; milder palsies require neuro-ophthalmologic assessment and/or Lancaster test. Pituitary apoplexy induces ocular motor impairment in 70% of cases, strongly guiding diagnosis. Visual impairment is associated in 75% of cases. The degree of neuro-ophthalmologic (visual and ocular motor) impairment is one of the main criteria guiding treatment of pituitary apoplexy (conservative medical and/or surgical treatment) and follow-up.
Collapse
Affiliation(s)
- Lucie Abouaf
- Unité de neuro-ophtalmologie, service de neurologie D, hôpital neurologique, hospices civils de Lyon, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Université Claude-Bernard Lyon-1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France.
| | - Alain Vighetto
- Unité de neuro-ophtalmologie, service de neurologie D, hôpital neurologique, hospices civils de Lyon, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Université Claude-Bernard Lyon-1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France
| | - Maud Lebas
- Clinique Mathilde, 4, rue Lessard, 76100 Rouen, France
| |
Collapse
|
18
|
Teasdale S, Hashem F, Olson S, Ong B, Inder WJ. Recurrent pituitary apoplexy due to two successive neoplasms presenting with ocular paresis and epistaxis. Endocrinol Diabetes Metab Case Rep 2015; 2015:140088. [PMID: 25755879 PMCID: PMC4322370 DOI: 10.1530/edm-14-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/19/2015] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED A case of recurrent pituitary apoplexy is described in a 72-year-old man who initially presented with haemorrhage in a non-functioning pituitary adenoma. Five years later, he re-presented with a severe pituitary haemorrhage in an enlarging sellar mass invading both cavernous sinuses causing epistaxis and bilateral ocular paresis. Subsequent histology was consistent with a sellar malignant spindle and round cell neoplasm. Multiple pituitary tumours have previously been reported to coexist in the same individual, but to our knowledge this is the only case where two pathologically distinct pituitary neoplasms have sequentially arisen in a single patient. This case is also notable with respect to the progressive ocular paresis, including bilateral abducens nerve palsies, and the presentation with epistaxis. LEARNING POINTS Ocular paresis in pituitary apoplexy can result from tumour infiltration of nerves, or by indirect compression via increased intrasellar pressure.Epistaxis is a very rare presentation of a pituitary lesion.Epistaxis more commonly occurs following trans-sphenoidal surgery, and can be delayed.
Collapse
Affiliation(s)
- Stephanie Teasdale
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Fahid Hashem
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Sarah Olson
- Department of Neurosurgery, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Benjamin Ong
- Department of Radiology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia ; School of Medicine, The University of Queensland Brisbane, Queensland , Australia
| |
Collapse
|
19
|
Adam MK, Krespan K, Moster ML, Sergott RC. Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis. Neuroophthalmology 2014; 38:230-237. [DOI: 10.3109/01658107.2014.902972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 12/18/2022] Open
|
20
|
Zoli M, Mazzatenta D, Pasquini E, Ambrosetto P, Frank G. Cavernous sinus apoplexy presenting isolated sixth cranial nerve palsy: case report. Pituitary 2012; 15 Suppl 1:S37-40. [PMID: 21503686 DOI: 10.1007/s11102-011-0312-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The clinical and radiological findings of a patient affected by apoplexy of an adenoma located within cavernous sinus and presenting isolated Cranial Nerve (CN) VI palsy are reported. The differential diagnosis with other pathologies is debated, and pathogenesis of isolated abducens nerve palsy is investigated. The pertinent literature of this uncommon case of apoplexy is reviewed. A 59-year-old female presented sudden appearance of CN VI palsy associated to violent headache. Endocrinological assessment did not show pituitary insufficiency; MRI depicted an adenoma located within the left CS. She underwent an endoscopic endonasal procedure with extensive opening of the cavernous sinus, occupied by an ischemic adenoma. Afterward, neurological symptoms promptly resolved and the patient was discharged after 5 days. At 3 months follow-up MRI radical tumor removal was assessed, and the patient resulted neurologically intact. The review of the pertinent literature shows that apoplexy of pituitary tumor exclusively located within the Cavernous Sinus is a very uncommon event. The distinctive clinical presentation is represented by the sudden abducens nerve palsy and the absence of pituitary insufficiency and it could be explained by the vulnerability of the nerve along its course within the cavernous sinus, and by the sparing of the sellar content by the adenoma.
Collapse
Affiliation(s)
- Matteo Zoli
- Center of Surgery for Pituitary Tumours, Department of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | | | | | | | | |
Collapse
|
21
|
Komurcu HF, Ayberk G, Ozveren MF, Anlar O. Pituitary adenoma apoplexy presenting with bilateral third nerve palsy and bilateral proptosis: a case report. Med Princ Pract 2012; 21:285-7. [PMID: 22156441 DOI: 10.1159/000334783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of pituitary adenoma apoplexy presenting with bilateral proptosis and bilateral third nerve palsy that developed after cardiovascular surgery. CLINICAL PRESENTATION AND INTERVENTION A 45-year-old man developed bilateral proptosis and bilateral third nerve palsy after a coronary artery bypass grafting operation. A pituitary macroadenoma with extension into the sphenoid sinus and cavernous sinus with bilateral involvement was resected on computed tomography scan by microscopic transsphenoidal procedure. Third nerve palsy improved partially on the first postoperative day and completely improved in the fourth month after the operation. CONCLUSION This is a rare case of pituitary adenoma apoplexy that presented with bilateral third cranial nerve palsy.
Collapse
Affiliation(s)
- H Ferhan Komurcu
- Section of Neurology, Ataturk Training and Research Hospital, Ankara, Turkey.
| | | | | | | |
Collapse
|
22
|
Enatsu R, Asahi M, Matsumoto M, Hirai O. Pituitary Apoplexy Presenting Atypical Time Course of Ophthalmic Symptoms. TOHOKU J EXP MED 2012; 227:59-61. [DOI: 10.1620/tjem.227.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Rei Enatsu
- Department of Neurosurgery, Shinko Hospital
| | | | | | | |
Collapse
|
23
|
Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report. BMC Ophthalmol 2011; 11:4. [PMID: 21272327 PMCID: PMC3041999 DOI: 10.1186/1471-2415-11-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/27/2011] [Indexed: 11/21/2022] Open
Abstract
Background Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy. Case Presentation A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation. Conclusions This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.
Collapse
|
24
|
Abstract
This chapter covers the very large number of possible disorders that can affect the three ocular motor nerves, the neuromuscular junction, or the extraocular muscles. Conditions affecting the nerves are discussed under two major headings: those in which the site of damage can be anatomically localized (e.g., fascicular lesions and lesions occurring in the subarachnoid space, the cavernous sinus, the superior orbital fissure, or the orbit) and those in which the site of the lesion is either nonspecific or variable (e.g., vascular lesions, tumors, "ophthalmoplegic migraine," and congenital disorders). Specific comments on the diagnosis and management of disorders of each of the three nerves follow. Ocular motor synkineses (including Duane's retraction syndrome and aberrant regeneration) and disorders resulting in paroxysms of excess activity (e.g., neuromyotonia) are then covered, followed by myasthenia gravis and other disorders that affect the neuromuscular junction. A final section discusses disorders of the extraocular muscles themselves, including thyroid disease, orbital myositis, mitochondrial disease, and the muscular dystrophies.
Collapse
Affiliation(s)
- Christian J Lueck
- Department of Neurology, The Canberra Hospital, and Australian National University Medical School, Canberra, Australia.
| |
Collapse
|
25
|
Liniker E, Hyatt P. Temporary bilateral oculomotor nerve palsy as the sole presenting sign of a pituitary mass. BMJ Case Rep 2009; 2009:bcr08.2009.2193. [PMID: 22110556 DOI: 10.1136/bcr.08.2009.2193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old patient presented with isolated bilateral third nerve palsy. Neuroimaging demonstrated a 2 cm pituitary mass with extension into the cavernous sinus on the right. The patient went on to experience spontaneous complete resolution of symptoms with associated radiological shrinkage of the mass. Bilateral third nerve palsy is a very rare presenting sign, with only one previous case reported in the literature secondary to a pituitary adenoma. Spontaneous resolution of non-functioning pituitary tumours is reported to occur in approximately 10% of cases. However, there are only a small number of reports to date involving spontaneous regression of tumours with corresponding resolution of cranial nerve palsies.
Collapse
Affiliation(s)
- Elizabeth Liniker
- North Middlesex University Hospital, Endocrinology and Diabetes, Sterling Way, London N18 1QX, UK
| | | |
Collapse
|