Dr.SUSHMA TULAVA
Spontaneous pituitary apoplexy with varying neuro-ophthalmic presentation in the absence of pre-existing pituitary adenoma is quite rare. A 45-year-old male patient presented with sudden onset of severe headache, vomiting, bilateral decreased vision (VA:RE-PL+, LE-1/60), complete ptosis and ophthalmoplegia for seven-days duration. Brain magnetic resonance imaging showed a sellar and suprasellar expansile lesion(4*4*3.5 cm) with of necrosis and hemorrhagic apoplexy compressing optic chiasma superiorly and cavernous sinus structures on both sides including 3rd, 4th, 6th cranial nerves. He underwent trans-sphenoidal microscopic near total excision of pituitary tumour and following which there was significant improvement in vision (BCVA:RE-6/9, LE-6/6), ophthalmoplegia, ptosis with normal visual fields. This is a medical emergency and a difficult diagnosis to establish that necessitates multidisciplinary approach.
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