Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes

2020 ◽  
Vol 13 (6) ◽  
pp. e232490
Author(s):  
Divya Natarajan ◽  
Suresh Tatineni ◽  
Srinivasa Perraju Ponnapalli ◽  
Virender Sachdeva
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Lateral Spread ◽  
Automated Perimetry ◽  
Third Cranial Nerve Palsy ◽  
The Right

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.

Radiosurgical Management of Benign Cavernous Sinus Tumors: Dose Profiles and Acute Complications

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 1022-1032 ◽  
Author(s):  
Joseph C.T. Chen ◽  
Steven L. Giannotta ◽  
Cheng Yu ◽  
Zbigniew Petrovich ◽  
Michael L. Levy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pituitary Adenoma ◽  
Radiation Dose ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Tumor Volume ◽  
Grade Iii

Abstract OBJECTIVE Radiosurgery has emerged as an alternative treatment modality for cranial base tumors in patients deemed not suited for primary surgical extirpation, patients with recurrent or residual tumor after open surgery, or patients who refuse surgical treatment. We review our short-term experience with radiosurgical management of cavernous sinus region tumors with the Leksell gamma knife. METHODS From August 1994 to February 1999, 69 patients with cavernous sinus lesions were treated in 72 separate treatment sessions. The tumor type distribution was 29 pituitary adenomas, 35 meningiomas, 4 schwannomas, and 1 paraganglioma. The median follow-up was 122 weeks. Lesions were stratified according to a five-level surgical grade. The grade distribution of the tumors was as follows: Grade I, 13; Grade II, 21; Grade III, 19; Grade IV, 12; Grade V, 4. Median tumor volume was 4.7 cm3. The median radiation dose was 15 Gy to the 50% isodose line. Median maximal radiation dose was 30 Gy. RESULTS Analysis of tumor characteristics and radiation dose to optic nerve and pontine structures revealed a significant correlation between distance and dose. Much lower correlation coefficients were found between tumor volume and dose. One lesion in this series had evidence of transient progression and later regression on follow-up radiographic studies. No other lesions in this series were demonstrated to have exhibited progression. Complications after radiosurgical treatment were uncommon. Two patients had cranial nerve deficits after treatment. One patient with a surgical Grade III pituitary adenoma had VIth cranial nerve palsy 25 months after radiosurgical treatment that spontaneously resolved 10 months later. A patient with a bilateral pituitary adenoma experienced bilateral VIth cranial nerve palsy 3 months after treatment that had not resolved at 35 months after treatment. Six patients with preoperative cranial nerve deficits experienced resolution or improvement of their deficits after treatment. One patient with a prolactin-secreting adenoma experienced normalization of endocrine function with return of menses. CONCLUSION Radiosurgical treatment represents an important advance in the management of cavernous sinus tumors, with low risk of neurological deficit in comparison with open surgical treatment, even in patients with high surgical grades.

Isolated third cranial nerve palsy as the first presentation of multiple myeloma

2021 ◽  
Vol 14 (3) ◽  
pp. e239917
Author(s):  
Tejasvini Vaid ◽  
Rishi Dhawan ◽  
Mukul Aggarwal ◽  
Seema Tyagi
Keyword(s):  
Multiple Myeloma ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cns Involvement ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Third Cranial Nerve Palsy ◽  
The Right ◽  
Rare Diagnosis

A 50-year-old woman presented with a right-sided isolated third cranial nerve palsy. MRI brain showed a mass lesion arising from the right clivus with extension into the cavernous sinus. Blood investigations and bone marrow biopsy were suggestive of multiple myeloma with hypercalcaemia and renal dysfunction. It was unclear at first if the intracranial lesion was due to myelomatous involvement or a separate disease entirely. The patient declined consent for a biopsy and cerebrospinal fluid analysis was inconclusive. She was treated with bortezomib based chemotherapy and the palsy resolved by day 6, which helped clinch the rare diagnosis of central nervous system (CNS) involvement by multiple myeloma. Most patients with CNS myeloma have a dismal survival of under 6 months but she is on therapy for relapse 26 months after diagnosis. While placed under the umbrella of CNS myeloma, patients with osteodural myeloma have better outcomes, perhaps due to their distinct aetiopathogenesis.

scholarly journals Interdural cavernous sinus dermoid cyst in a child: case report

2017 ◽  
Vol 19 (3) ◽  
pp. 354-360 ◽  
Author(s):  
Flavio Giordano ◽  
Giacomo Peri ◽  
Giacomo M. Bacci ◽  
Massimo Basile ◽  
Azzurra Guerra ◽  
...  
Keyword(s):  
Case Report ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Lateral Wall ◽  
Total Removal ◽  
Pediatric Case ◽  
Third Cranial Nerve Palsy ◽  
The Right

Interdural dermoid cysts (DCs) of the cavernous sinus (CS), located between the outer (dural) and inner layer (membranous) of the CS lateral wall, are rare lesions in children. The authors report on a 5-year-old boy with third cranial nerve palsy and exophthalmos who underwent gross-total removal of an interdural DC of the right CS via a frontotemporal approach. The patient had a good outcome and no recurrence at the 12-month follow-up. To the best of the authors' knowledge this is the second pediatric case of interdural DC described in the literature.

scholarly journals Parésia do Nervo Motor Ocular Comum em Contexto de Sinusite Esfenoidal

2014 ◽  
Vol 27 (6) ◽  
pp. 782 ◽  
Author(s):  
Luís Almeida Dores ◽  
Marco Alveirinho Simão ◽  
Marta Canas Marques ◽  
Óscar Dias
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Sphenoid Sinus ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Intravenous Antibiotics ◽  
Motor Nerves ◽  
Third Cranial Nerve Palsy ◽  
High Index Of Suspicion

Sphenoid sinus disease is particular not only for its clinical presentation, as well as their complications. Although rare, these may present as cranial nerve deficits, so it is important to have a high index of suspicion and be familiar with its diagnosis and management. Symptoms are often nonspecific, but the most common are headache, changes in visual acuity and diplopia due to dysfunction of one or more ocular motor nerves. The authors report a case of a 59 years-old male, who was referred to the ENT emergency department with frontal headaches for one week which had progressively worsened and were associated, since the last 12 hours, with diplopia caused by left third cranial nerve palsy. Neurologic examination was normal aside from the left third cranial nerve palsy. Anterior and posterior rhinoscopy excluded the presence of nasal masses and purulent rhinorrhea. The CT scan revealed a soft tissue component and erosion of the roof of the left sphenoid sinus. Patient was admitted for intravenous antibiotics and steroids treatment without any benefit after 48 hours. He was submitted to endoscopic sinus surgery with resolution of the symptoms 10 days after surgery. The authors present this case for its rarity focusing on the importance of differential diagnosis in patients with headaches and cranial nerves palsies.<br /><strong>Keywords:</strong> Sphenoid Sinusitis; Oculomotor Nerve Diseases.

Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy

2019 ◽  
pp. 112067211987327
Author(s):  
Raida Ben Salah ◽  
Sonda Kammoun ◽  
Faten Frikha ◽  
Yosra Bouattour ◽  
Imen Chabchoub ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Lymphoblastic Lymphoma ◽  
Cranial Neuropathy ◽  
Atypical Case ◽  
The Third ◽  
Non Hodgkin Lymphoma ◽  
Third Cranial Nerve Palsy

Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.

Imaging of Oculomotor (Third) Cranial Nerve Palsy

2019 ◽  
pp. 133-151 ◽  
Author(s):  
Michael S. Vaphiades ◽  
Martin W. ten Hove ◽  
Tim Matthews ◽  
Glenn H. Roberson ◽  
Alexandra Sinclair
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Third Cranial Nerve Palsy
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