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<h5 class="section-title" id="d5153498e195">Background</h5>
<p id="P2">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 PA patients.
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<h5 class="section-title" id="d5153498e200">Methods</h5>
<p id="P3">A retrospective chart review of all patients with PA seen in our Pituitary
Center
(1/1995–12/2012) was conducted. Presenting neuro-ophthalmic, endocrine, and radiologic
data as well as neuro-ophthalmology follow-up were collected.
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<h5 class="section-title" id="d5153498e205">Results</h5>
<p id="P4">We identified 235 PA patients, among whom 59 (25%) had OMD; 27/59 had neuro-ophthalmic
evaluation. Pre-operatively, 23/27 patients had unilateral OMD, 18/23 (78%) had single
and 5/23 (22%) multiple CNPs. Bilateral OMD was present in 4/27 patients. Postoperatively,
24/27 OMD patients had follow-up (median duration: 7 months [IQR: 3–17]). At last
post-operative follow-up, 7/24 (29%) patients had OMD (5 unilateral, 2 bilateral).
OMD resolved in 3/24 (12%) patients within 1 month, 13/21(62%) patients within 6 months
(3 lost to follow-up), and 17/19 (89%) within one year (2 lost to follow-up). Surgery
occurred ≤14 days post-presentation in 16/18 (89%) of resolved vs. 4/6 (67%) of 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).
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<h5 class="section-title" id="d5153498e210">Conclusion</h5>
<p id="P5">Ocular motility dysfunction from cranial nerve palsies is common in PA,
occurring
in one-quarter of patients, and are more frequently associated with certain radiologic,
endocrinologic, and pathologic features. The prognosis is excellent, with 90% of OMD
resolved at one year after early pituitary surgery.
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