Editors' Note: Pearls & Oy-sters: Isolated Oculomotor Nerve Palsy due to Pituitary Apoplexy Missed on CT Scan

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.

Download Full-text

A case with pituitary apoplexy presenting with isolated oculomotor nerve palsy: Case report and literature review

Dicle Medical Journal / Dicle Tip Dergisi ◽

10.5798/diclemedj.0921.2014.02.0442 ◽

2014 ◽

Vol 41 (2) ◽

pp. 409-413

Author(s):

Betül Çevik ◽

Keyword(s):

Case Report ◽

Literature Review ◽

Nerve Palsy ◽

Pituitary Apoplexy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy

Download Full-text

ISOLATED OCULOMOTOR NERVE PALSY

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.5.1.2013.2048 ◽

2013 ◽

Vol 5 (1) ◽

Author(s):

Melissa T. E. Ratag ◽

Ralf R Pangalila

Keyword(s):

Ct Scan ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Uncontrolled Hypertension ◽

Oculomotor Nerve Palsy ◽

Relative Afferent Pupillary Defect ◽

Primary Position ◽

Normal Limits ◽

The Right ◽

Per Oral

Abstract: We reported a case of a 59-year-old male who came to the hospital with the chief complaint of a droopy upper right eyelid originating a month before, accompanied by diplopia. This patient was also suffering from uncontrolled hypertension. The ophthalmologic examination of the right eye showed a best corrected visual acuity (BCVA) of 1.0. In the primary position there was a deviation to the temporal side; limitations on elevation, adduction, and depression; and an endorotation on nasal down gaze. The aberrant regenerative trigeminal nerve was noticed, but the relative afferent pupillary defect (RAPD) was not found. The anterior and posterior segments of the right eye were normal. Laboratory tests were within normal limits and the CT-scan did not show any abnormality. Conclusion: Based on all the tests performed, the diagnosis of the patient was an isolated oculomotor nerve palsy of the right eye. The patient was treated with a non-steroid anti inflammatory drug and a neurotropic vitamine, and had to be observed for three months. Keywords: palsy, oculomotor nerve, right eye. Abstrak: Kami melaporkan kasus seorang laki-laki berusia 59 tahun dengan keluhan utama kelopak mata atas kanan tertutup sejak satu bulan lalu, disertai diplopia. Dalam anamnesis ditemukan adanya riwayat hipertensi sedangkan riwayat trauma tidak ada. Pemeriksaan oftalmologi mata kanan didapatkan tajam penglihatan 6/6, pergerakan bola mata kanan tampak sedikit deviasi ke temporal pada posisi primer, serta keterbatasan dalam elevasi, aduksi, dan depresi. Mata kanan tampak endorotasi saat melirik ke nasal bawah dan terdapat aberrant regenerative; relative afferent pupillary defect (RAPD) tidak ditemukan. Segmen anterior dan posterior dalam batas normal. Pemeriksaan laboratorium dan CT scan kepala dalam batas normal. Simpulan: Berdasarkan hasil pemeriksaan oftalmologik dan pemeriksaan penunjang ditegakkan diagnosis isolated oculomotor nerve palsy mata kanan yang ditangani dengan pemberian anti inflamasi non steroid dan neurotropik per oral sambil diobservasi selama tiga bulan. Kata kunci: kelumpuhan, saraf okulomotor, mata kanan.

Download Full-text