Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a
pituitary adenoma or an adjacent pituitary gland.
Pituitary apoplexy may be associated with a variety of neurological and endocrinological signs and symptoms. However, isolated third cranial nerve
palsy with ptosis as the presenting sign of
pituitary apoplexy is very rare. We describe two cases of
pituitary apoplexy presenting as sudden-onset unilateral ptosis and
diplopia. In one case, brain magnetic resonance imaging (MRI) revealed a mass in the pituitary fossa with signs of
hemorrhage, upward displacement of the optic chiasm, erosion of the sellar floor and invasion of the right cavernous sinus. In the other case, MRI showed a large area of insufficient enhancement in the anterior pituitary consistent with pituitary
infarction or
Sheehan's syndrome. We performed neurosurgical
decompression via a transsphenoidal approach. Both patients showed an uneventful recovery. Both cases of isolated third cranial nerve
palsy with ptosis completely resolved during the early postoperative period. We suggest that
pituitary apoplexy should be included in the differential diagnosis of patients presenting with isolated third cranial nerve
palsy with ptosis and that prompt neurosurgical
decompression should be considered for the preservation of third cranial nerve function.