Pituitary apoplexy with acute complete bilateral third nerve palsy and papillary involvement: A case report

Abstract

Pituitary apoplexy (PA) is a rare, potentially life-threatening condition primarily associated with pituitary adenomas. It presents with sudden, severe symptoms due to inadequate blood supply, bleeding, or tissue death in the pituitary gland. This case report describes a case of PA in a 40-year-old female, and reviews the recent literature surrounding the subject. The patient presented with complete bilateral third nerve palsy and dilated non-reactive pupils. Her initial symptoms included retroorbital headache, fever, and double vision, which rapidly progressed to oculomotor nerve palsy. MRI revealed hemorrhagic PA. High-dose steroids were initiated, leading to the resolution of ptosis. Additionally, surgical intervention was performed. PA typically affects older males with known adenomas, making this case unusual due to the patient's age, gender, and absence of prior adenoma history. Differentiating PA from other intracranial pathologies is crucial, and MRI plays a pivotal role in accurate diagnosis.

Keywords

• pituitary
• apoplexy
• oculomotor nerve palsy
• headache
• ptosis
• transnasasl surgery