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 1).
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 2) 3).
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.