scholarly journals Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Nooshin Salehi ◽  
Anthony Firek ◽  
Iqbal Munir
Keyword(s):  
Ct Scan ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Altered Level ◽  
Level Of Consciousness ◽  
The Right

Background. Pituitary apoplexy (PA) is a clinical syndrome caused by acute ischemic infarction or hemorrhage of the pituitary gland. The typical clinical presentation of PA includes acute onset of severe headache, visual disturbance, cranial nerve palsy, and altered level of consciousness. Case Report. A 78-year-old man presented to the emergency department with one-day history of ptosis and diplopia and an acute-onset episode of altered level of consciousness which was resolving. He denied having headache, nausea, or vomiting. Physical examination revealed third-cranial nerve palsy and fourth-cranial nerve palsy both on the right side. Noncontrast computed tomography (CT) scan of the head was unremarkable. Brain magnetic resonance imaging (MRI) showed a pituitary mass with hemorrhage (apoplexy) and extension to the right cavernous sinus. The patient developed another episode of altered level of consciousness in the hospital. Transsphenoidal resection of the tumor was done which resulted in complete recovery of the ophthalmoplegia and mental status. Conclusion. Pituitary apoplexy can present with ophthalmoplegia and altered level of consciousness without having headache, nausea, or vomiting. A CT scan of the head could be negative for hemorrhage. A high index of suspicion is needed for early diagnosis and timely management of pituitary apoplexy.

scholarly journals Prognosis of bacterial meningitis in children

1996 ◽  
Vol 54 (3) ◽  
pp. 407-411 ◽  
Author(s):  
Irenio Gomes ◽  
Ailton Melo ◽  
Rita Lucena ◽  
Marco Heleno Cunha-Nascimento ◽  
Adriana Ferreira ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Acute Bacterial Meningitis ◽  
Subdural Effusion ◽  
Level Of Consciousness ◽  
Important Health ◽  
Meningitis In Children ◽  
The Impact

We studied the incidence and prognosis of acute neurologic complications in 281 children under 13 years of age with a diagnosis of acute bacterial meningitis. All the patients were examined daily by the same group of neurologists, using a standardized neurological examination. Patients with signs of encephalic lesions, unsatisfactory response to antibiotics or decreased level of consciousness were submitted to brain computer tomography. The overall lethality rate was 20.3% and cases whose causative agent was identified presented a higher lethality rate (23.7%) than those in which the agent was not found. The most important neurological abnormalities were meningeal signs (88.3%) followed by decreased consciousness (47.7%), irritability (35.2%), seizures (22.4%), fontanel bulging (20.6%) and cranial nerve palsy (14.2%). Seizures, cranial nerve palsy and the absence of meningeal signs were related to higher rates of lethality. Diminished consciousness, seizures, subdural effusion, abscess and hydrocephalus were the most important complications, respectively. We can conclude that acute bacterial meningitis continues to be an important health problem in developing countries and that public health measures will be necessary to minimize the impact of sequelae and reduce the mortality rate in children with that pathology.

Pituitary adenoma presenting as acute onset isolated complete third cranial nerve palsy without vision changes

2020 ◽  
Vol 13 (6) ◽  
pp. e232490
Author(s):  
Divya Natarajan ◽  
Suresh Tatineni ◽  
Srinivasa Perraju Ponnapalli ◽  
Virender Sachdeva
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Lateral Spread ◽  
Automated Perimetry ◽  
Third Cranial Nerve Palsy ◽  
The Right

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.

Isolated third cranial nerve palsy as the first presentation of multiple myeloma

2021 ◽  
Vol 14 (3) ◽  
pp. e239917
Author(s):  
Tejasvini Vaid ◽  
Rishi Dhawan ◽  
Mukul Aggarwal ◽  
Seema Tyagi
Keyword(s):  
Multiple Myeloma ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Cns Involvement ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Third Cranial Nerve Palsy ◽  
The Right ◽  
Rare Diagnosis

A 50-year-old woman presented with a right-sided isolated third cranial nerve palsy. MRI brain showed a mass lesion arising from the right clivus with extension into the cavernous sinus. Blood investigations and bone marrow biopsy were suggestive of multiple myeloma with hypercalcaemia and renal dysfunction. It was unclear at first if the intracranial lesion was due to myelomatous involvement or a separate disease entirely. The patient declined consent for a biopsy and cerebrospinal fluid analysis was inconclusive. She was treated with bortezomib based chemotherapy and the palsy resolved by day 6, which helped clinch the rare diagnosis of central nervous system (CNS) involvement by multiple myeloma. Most patients with CNS myeloma have a dismal survival of under 6 months but she is on therapy for relapse 26 months after diagnosis. While placed under the umbrella of CNS myeloma, patients with osteodural myeloma have better outcomes, perhaps due to their distinct aetiopathogenesis.

scholarly journals A rare case of iii cranial nerve palsy - mucormycosis involving the right maxillary and ethmoidal sinus

2021 ◽  
Vol 9 (3) ◽  
pp. 181-184
Author(s):  
K. Praveen Gandhi ◽  
◽  
V. Sakthivel ◽  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Rare Case ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
The Right ◽  
Rule Out

IIIrd Cranial nerve palsy, known as oculomotor nerve palsy, may result from various causes,however, the etiology remains unknown in some instances. This case report aims to present theauthors' experience with a case of IIIrd cranial nerve palsy, together with a review of the literature.Many etiologies have been associated with isolated oculomotor nerve palsies. We report the case ofa patient who presented with right maxillary and ethmoidal sinusitis with IIIrd cranial nerve palsyassociated with mucormycosis. Careful examinations to rule out other causes must be done and thentreatment with antifungals should be considered after early diagnosis.

scholarly journals A Rare Case of Traumatic Bilateral Sixth Cranial Nerve Palsy

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Hamidon BB ◽  
Md Shariful HS ◽  
Nasaruddin MZ
Keyword(s):  
Cervical Spine ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Cervical Spine Fracture ◽  
Sixth Cranial Nerve ◽  
Altered Level ◽  
Sixth Cranial Nerve Palsy

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.

Isolated Third Cranial Nerve Palsy in Pituitary Apoplexy: Case Report and Systematic Review

2021 ◽  
Vol 30 (9) ◽  
pp. 105969
Author(s):  
Michela Rosso ◽  
Srinath Ramaswamy ◽  
Heidi Sucharew ◽  
Achala Vagal ◽  
Yaacov Anziska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Third Cranial Nerve Palsy

Isolated Unilateral Abducens Cranial Nerve Palsy: A Rare Presentation of Pituitary Apoplexy

2010 ◽  
Vol 20 (1) ◽  
pp. 234-236 ◽  
Author(s):  
Albert I. Matti ◽  
Adam K. Rudkin ◽  
Andrew W. Lee ◽  
Celia S. Chen
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rare Presentation
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