Isolated abducens nerve palsy due to pituitary apoplexy after mild head trauma

• Published in: The American journal of emergency medicine 2015-10, Vol.33 (10), p.1539.e3-1539.e4
• Main Authors: Kayayurt, Kamil, MD, Gündogdu, Ömer Lütfi, MD, Yavaşi, Özcan, MD, Metin, Yavuz, MD, Ugras, Erhan, MD
• Format: Article
• Language: English
• Subjects: Abducens Nerve Diseases - diagnosis; Abducens Nerve Diseases - etiology; Aged; Anesthesia; Coma; Consciousness; Craniocerebral Trauma - complications; Diagnostic Imaging; Emergency; Emergency medical care; Emergency Service, Hospital; Head injuries; Humans; Male; Medical imaging; Nausea; NMR; Nuclear magnetic resonance; Patients; Pituitary Apoplexy - diagnosis; Pituitary Apoplexy - etiology; Pituitary gland; Surgery; Trauma; Tumors; Vomiting
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.07.066

Pituitary apoplexy is a relatively rare condition. Cranial nerve palsies may develop due to compression of the surrounding structures by the rapidly expanding tumor. While the most commonly affected nerve is the oculomotor nerve, abducens nerve palsy may also occur less commonly. A 68-year-old male patient was admitted to the emergency department with complaints of severe headache, nausea, vomiting, and diplopia after head trauma due to falling. His magnetic resonance imaging evaluation demonstrated a large pituitary adenoma and bleeding into the tumor, which was acutely expanding and leading to compression of the abducens nerve laterally. Isolated abducens palsy due to posttraumatic pituitary apoplexy is a rare clinical condition, and as the symptoms and signs are nonspecific, it can commonly remain clinically undiagnosed. In this article, our aim was to draw attention to a clinical condition in which unfavorable complications may develop if the diagnosis is overlooked.