Temporary bilateral oculomotor nerve palsy as the sole presenting sign of a pituitary mass

Abstract

A 65-year-old patient presented with isolated bilateral third nerve palsy. Neuroimaging demonstrated a 2 cm pituitary mass with extension into the cavernous sinus on the right. The patient went on to experience spontaneous complete resolution of symptoms with associated radiological shrinkage of the mass. Bilateral third nerve palsy is a very rare presenting sign, with only one previous case reported in the literature secondary to a pituitary adenoma. Spontaneous resolution of non-functioning pituitary tumours is reported to occur in approximately 10% of cases. However, there are only a small number of reports to date involving spontaneous regression of tumours with corresponding resolution of cranial nerve palsies.

Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

“…Again, multiple cranial nerves are typically involved. Primary and metastatic neoplasms can produce bilateral ophthalmoplegia via infiltration of the cerebral peduncles, 29,30 cavernous sinus, 31 or meninges. 32,33 Neuroimaging focusing on the orbits, cavernous sinus, and skull base is essential to arrive to the diagnosis, followed at times by LP for CSF glucose and protein analysis and cytology to search for malignant cells.…”