title: Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Apoplexy.
abstract: BACKGROUND
  Pituitary apoplexy (PA) often presents with acute headache and neuro-ophthalmic manifestations, including ocular motility dysfunction (OMD) from cranial nerve palsies (CNPs). Our goal was to describe the epidemiology and outcomes of OMD in a large, single-center series of patients with PA.
  
  
  METHODS
  We conducted a retrospective chart review of all patients with PA seen in our pituitary center between January 1995 and December 2012. Presenting neuro-ophthalmic, endocrine, and radiologic data, as well as neuro-ophthalmology follow-up data, were collected.
  
  
  RESULTS
  We identified 235 patients with PA, 59 of whom (25%) had OMD. Twenty-seven of those 59 patients underwent neuro-ophthalmic evaluation. Preoperatively, 23 of these 27 patients had unilateral OMD, 18 (78%) with a single CNP and 5 (22%) with multiple CNPs. Bilateral OMD was present in 4 of the 27 patients. Postoperatively, 24 of the 27 patients with OMD had follow-up (median duration, 7 months; interquartile range [IQR], 3-17 months). At the last postoperative follow-up, 7 of these 24 patients (29%) had OMD (5 unilateral, 2 bilateral). OMD resolved in 3 of the 24 patients (12%) within 1 month, in 13 of 21 patients (62%) within 6 months (3 lost to follow-up), and in 17 of 19 patients (89%) within 1 year (2 lost to follow-up). Surgery was performed at ≤14 days after presentation in 16 of 18 (89%) resolved cases and in 4 of 6 (67%) unresolved cases. Patients with OMD were more likely than those without OMD to have larger tumors (2.6 vs. 2.0 cm; P < 0.001), panhypopituitarism (31% vs. 14%; P = 0.005), and necrosis (58% vs. 37%; P = 0.03).
  
  
  CONCLUSIONS
  OMD from CNPs is common in PA, occurring in one-quarter of patients, and is frequently associated with certain radiologic, endocrinologic, and pathological features. The prognosis is excellent, with 90% of cases of OMD resolving by 1 year after early pituitary surgery.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.
authors.forename: Rabih
authors.initials: R
authors.lastname: Hage
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Eshraghi
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA; Department of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Adriana G
authors.initials: AG
authors.lastname: Ioachimescu
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA; Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA; Department of Neurology, Emory University, Atlanta, Georgia, USA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Newman
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA; Department of Neurology, Emory University, Atlanta, Georgia, USA.
authors.forename: Valérie
authors.initials: V
authors.lastname: Biousse
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA; Department of Neurology, Emory University, Atlanta, Georgia, USA; Department of Epidemiology, Emory University, Atlanta, Georgia, USA. Electronic address: bbbruce@emory.edu.
authors.forename: Beau B
authors.initials: BB
authors.lastname: Bruce
mesh_terms: D020434:Abducens Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003389:Cranial Nerve Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020432:Trochlear Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology
keywords: Cranial nerve palsy; Diplopia; Pituitary adenoma; Pituitary apoplexy