A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases

• Published in: Acta neurochirurgica Vol. 153; no. 12; pp. 2453 - 2456
• Main Authors: Kobayashi, Hiroyuki, Kawabori, Masahito, Terasaka, Shunsuke, Murata, Junichi, Houkin, Kiyohiro
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.12.2011; Springer Nature B.V
• Subjects: Adenoma; Adenoma - complications; Adenoma - diagnostic imaging; Adenoma - pathology; Aged, 80 and over; Case Report; Cavernous Sinus - diagnostic imaging; Cavernous Sinus - pathology; Computed tomography; Hemorrhage; Humans; Interventional Radiology; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neoplasm Invasiveness - diagnostic imaging; Neoplasm Invasiveness - pathology; Neurology; Neuroradiology; Neurosurgery; Oculomotor nerve; Oculomotor Nerve Diseases - diagnostic imaging; Oculomotor Nerve Diseases - etiology; Oculomotor Nerve Diseases - pathology; Paralysis; Pituitary; Pituitary Apoplexy - complications; Pituitary Apoplexy - diagnostic imaging; Pituitary Apoplexy - pathology; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - pathology; Radiography; Sinus; Surgical Orthopedics; Tumors; Cavernous Sinus; Oculomotor Nerve; Pituitary Adenoma; Pituitary Apoplexy; Pituitary Tumor
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-011-1165-4

Isolated oculomotor nerve palsy occasionally occurs in patients with cavernous sinus invasion with or without pituitary apoplexy. We describe two cases of pituitary apoplexy without cavernous sinus invasion presenting with isolated oculomotor palsy. In both cases, computed tomography (CT) showed erosion of the right posterior clinoid process. Magnetic resonance imaging (MRI) depicted pituitary adenoma with apoplexy protruding latero-posteriorly to the right cavernous sinus. The medio-posterior wall of the cavernous sinus was markedly displaced latero-posteriorly by the tumor, and there was no evidence of cavernous sinus invasion. Oculomotor palsy may be caused first by unilateral erosion of the posterior clinoid process, resulting in latero-posterior protrusion of the adenoma. Hemorrhage may result in sudden kinking of the oculomotor nerve at the entrance of the oculomotor trigone.