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Case report
Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes
  1. Divya Natarajan1,
  2. Suresh Tatineni2,
  3. Srinivasa Perraju Ponnapalli3 and
  4. Virender Sachdeva4
  1. 1Fellow Academy of Eye Care Education, Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Nimmagadda Prasad Children Eye Care Centre, LV Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
  2. 2Department of Neurosurgery, My Cure Hospital, Visakhapatnam, Andhra Pradesh, India
  3. 3Department of Radiology, Vijaya Medical Centre, Visakhapatnam, Andhra Pradesh, India
  4. 4Child Sight Institute, Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Nimmagadda Prasad Children Eye Care Centre, LV Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh, India
  1. Correspondence to Dr Virender Sachdeva; vsachdeva{at}lvpei.org

Abstract

We report a case of isolated unilateral complete pupil involving third cranial nerve palsy due to pituitary adenoma with parasellar extension into the right cavernous sinus. The patient was referred to us from neurosurgery with sudden onset binocular vertical diplopia with complete ptosis, and mild right-sided headache of 5-day duration. Ocular examination revealed pupil involving third cranial nerve palsy in right eye while rest of the examination including automated perimetry was normal. MRI brain with contrast revealed a mass lesion with heterogenous enhancement in the sella suggestive of a pituitary macroadenoma with possible internal haemorrhage (apoplexy). In addition, the MRI showed lateral spread to the right cavernous sinus which was causing compression of the right third cranial nerve. The patient was systemically stable. This report highlights a unique case as the lesion showed a lateral spread of pituitary adenoma without compression of the optic chiasm or other cranial nerves.

  • cranial nerves
  • neuroimaging
  • neuroopthalmology
  • visual pathway
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Footnotes

  • Contributors Concept and design: VS. Manuscript preparation and collection of data: VS, DN. Critical revision of the manuscript: VS, DN, ST, SPP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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