OPTOMOTOR PALSIES IN PITUITARY APOPLEXY

Optomotor palsy in pituitary adenomas is normally rare. Contrary to this, pituitary apoplexy presents in nearly 100% with ophthalmoplegia or a combination of various optomotor nerve palsies. Acute hemorrhage or ischemic infarction in a previously mostly unknown pituitary adenoma leads to sudden enlargement of the tumor. When the adenoma is growing slowly, the optomotor nerves seem able to adapt to the stretching without neurologic deficit, while a chiasmal syndrome may occur. Sudden, 'apoplectic' enlargement, however, is characterized first of all by oculomotor nerve deficit, followed by lesions of the abducens nerve, and the trochlear nerve with less frequency. Surgical decompression is required within two weeks, and provides a good prognosis for recovery of the neuro-ophthalmologic lesions.