Manipal Journal of Medical Sciences


A 37 year old lady presented to the hospital with severe headache. The lady had prior episodes of headache that lasted for 1 to 2 days and was associated with nausea, vomiting, photophobia and phonophobia. She was on treatment for episodic migraine. However, this time she had a severe and worse headache which was not improving on her regular medications. She had associated diplopia that she noted initially and had ptosis at the time of presentation to the hospital as well. Lady had ptosis with medial rectus palsy, with normal size normal reaction of pupil. There was mild frontal sinus tenderness. Pituitary tumours are most common type of disorders. The most common disorders that bring a patient to the hospital are pituitary adenoma. The emergency, pituitary apoplexy is a significant aetiology as well, that brings a person to a neurosurgeon. Pituitary apoplexy is defined as clinical syndrome that may include headache, visual defects, altered mental status. The symptoms may develop rapidly or evolve slowly over days to weeks. The most characteristic presenting features are inappropriate pituitary hormone secretion and visual field effects. Less commonly headache and subtle signs of pituitary hormone deficiency, such as amenorrhea, loss of libido and lethargy, are the presenting symptoms. Temporal lobe epilepsy, cranial nerve palsies, CSF rhinorrhea and hydrocephalus are rarer features. However, isolated third nerve palsy with ptosis are rare presenting feature.