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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0044-1791973
Review Article

Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy

Oday Atallah
1   Department of Neurosurgery, Hannover Medical School, Hannover, Germany
,
Amr Badary
2   Department of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
,
Vivek Sanker
3   Department of Neurosurgery, Trivandrum Medical College, Kerala, India
,
Wireko Andrew Awuah
4   Faculty of Medicine, Sumy State University, Sumy, Ukraine
,
Anil Ergen
5   Department of Neurosurgery, Derince Research Hospital, Kocaeli, Turkiye
,
Regunath Kandasamy
6   Department of Neurosurgery, Gleneagles Hospital, Kuala Lumpur
,
Bipin Chaurasia 
7   Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
› Institutsangaben Funding None.
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Abstract

Background Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland.

Methods A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases.

Results Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy.

Conclusion Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.

Keywords

abducens nerve palsy - sixth cranial nerve - pituitary adenoma - apoplexy

Availability of Data and Material

Data are provided in the manuscript.


Authors' Contributions

O.A. was responsible for planning and collection of data and writing of the manuscript. A.B., W.A.A., and V.S. edited the manuscript. B.C. and R.K. were responsible for critical review and editing of the manuscript.


Ethical Approval

The study was performed in compliance with the ethical standards of the institutional research committee.




Publikationsverlauf

Eingereicht: 05. März 2024

Angenommen: 01. Juli 2024

Artikel online veröffentlicht:
08. November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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