Pituitary apoplexy oculomotor nerve palsy [Neurosurgery Wiki]

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====== Pituitary apoplexy oculomotor nerve palsy ======

===== Etiology =====
Mechanical compression of the third cranial nerve against the unyielding [[interclinoid ligament]] of the cavernous sinus wall tends to bring about slow-onset nerve palsy.

Due to its location, the [[third cranial nerve]] is relatively more susceptible to the laterally transmitted pressure generated by an expanding pituitary mass abutting the cavernous sinus
((Rossitch E Jr, Carrazana EJ, Black PM. Isolated oculomotor nerve palsy
following apoplexy of a pituitary neuroendocrine tumor. J Neurosurg Sci. 1992
Apr-Jun;36(2):103-5. PubMed PMID: 1469470.
)).

Sudden onset [[oculomotor nerve palsy]] results from hemorrhage or infarct in the pre-existing [[pituitary]] mass and is attributed to the compromising of the vascular supply of the nerve, due to compression of the vasa nervosum originating in the [[internal carotid artery]]
((Cahill M, Bannigan J, Eustace P. Anatomy of the extraneural blood supply to
the intracranial oculomotor nerve. Br J Ophthalmol. 1996 Feb;80(2):177-81. PubMed
PMID: 8814752; PubMed Central PMCID: PMC505413.
))
((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. J Clin 
Neuroophthalmol. 1985 Sep;5(3):185-93. PubMed PMID: 2934421.)).


===== Case reports =====
Diyora B, Nayak N, Kukreja S, Kamble H. Sudden onset isolated complete third
nerve palsy due to pituitary apoplexy. Oman J Ophthalmol. 2011 Jan;4(1):32-4.
doi: 10.4103/0974-620X.77661. PubMed PMID: 21713240; PubMed Central PMCID:
PMC3110446.

Cho WJ, Joo SP, Kim TS, Seo BR. Pituitary apoplexy presenting as isolated
third cranial nerve palsy with ptosis : two case reports. J Korean Neurosurg Soc.
2009 Feb;45(2):118-21. doi: 10.3340/jkns.2009.45.2.118. Epub 2009 Feb 27. PubMed 
PMID: 19274125; PubMed Central PMCID: PMC2651557.

Bahmani Kashkouli M, Khalatbari MR, Yahyavi ST, Borghei-Razavi H,
Soltan-Sanjari M. Pituitary apoplexy presenting as acute painful isolated
unilateral third cranial nerve palsy. Arch Iran Med. 2008 Jul;11(4):466-8. doi:
08114/AIM.0022. PubMed PMID: 18588383.

Kim JP, Park BJ, Kim SB, Lim YJ. Pituitary Apoplexy due to pituitary neuroendocrine tumor
Infarction. J Korean Neurosurg Soc. 2008 May;43(5):246-9. doi:
10.3340/jkns.2008.43.5.246. Epub 2008 May 20. PubMed PMID: 19096606; PubMed
Central PMCID: PMC2588219.

Lee CC, Cho AS, Carter WA. Emergency department presentation of pituitary
apoplexy. Am J Emerg Med. 2000 May;18(3):328-31. PubMed PMID: 10830692.

Rossitch E Jr, Carrazana EJ, Black PM. Isolated oculomotor nerve palsy
following apoplexy of a pituitary neuroendocrine tumor. J Neurosurg Sci. 1992
Apr-Jun;36(2):103-5. PubMed PMID: 1469470.

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. J Clin 
Neuroophthalmol. 1985 Sep;5(3):185-93. PubMed PMID: 2934421.


François J, Neetens A. Oculomotor paralyses and tumors of the pituitary gland.
Confin Neurol. 1968;30(4):239-52. PubMed PMID: 5304123.