Pituitary Apoplexy With Bilateral Oculomotor Nerve Palsy

A 56-year-old man with a 1-year history of nonfunctioning pituitary adenoma presented to the emergency department with acute-onset headache and double vision. Examination demonstrated bilateral ptosis, bilaterally exotropic gaze with inability to adduct bilaterally, and dilated left pupil with decreased accommodation to light. Imaging revealed acute intralesional hemorrhage with invasion of cavernous sinus bilaterally (left more than right) and extension superiorly to the optic chiasm (Figure 1)