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Revista Medica Herediana

Print version ISSN 1018-130X


PINTO VALDIVIA, Miguel; ORTIZ TORRES, Milagros  and  VILLENA CHAVEZ, Jaime. Pituitary apoplexy presenting as isolated third cranial nerve palsy: A case report. Rev Med Hered [online]. 2011, vol.22, n.4, pp.186-189. ISSN 1018-130X.

A 65-year-old man came to Hospital Nacional Cayetano Heredia with severe headache and isolated left-sided ptosis. Physical examination showed isolated third cranial nerve palsy. Laboratory tests showed mild hyponatremia and hypopituitarism. Further work-up included a pituitary magnetic resonance imaging that demonstrated a mass in the pituitary fossa with signs of hemorrhage and invasion of left cavernous sinus. Treatment was started with glucocorticoid replacement and neurosurgical decompression via a transsphenoidal approach. Patient was discharged from hospital with replacement therapy of levothyroxine and prednisone. Left-sided ptosis was partially recovered. Pituitary apoplexy is a clinical syndrome characterized by abrupt onset headache, visual deficit, ophthalmoplegia and altered mental status caused by rapid enlargement of a pituitary adenoma, usually due to hemorrhagic infarction of the tumor. This expansive process can extends laterally into the cavernous sinus and compress the cranial nerves. Isolated third cranial nerve palsy is very rare. In most cases, improvement of cranial neuropathy is possible with rapid diagnosis and adequate and timely management.(Rev Med Hered 2011;22:186-189).

Keywords : Pituitary apoplexy; hypopituitarism; pituitary adenoma; third cranial nerve palsy.

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