Clinical Presentation

The signs and symptoms depend on the speed at which the pathological process progresses. Abrupt expansion of the intrasellar contents, after infarction or hemorrhage into a pituitary adenoma, causes a rapid onset of combined, often bilateral cranial neuropathies, associated with severe headache and uni- or bilateral, often profound, loss of vision. With a subarachnoid hemorrhage, the patient's condition can rapidly deteriorate to the level of a coma. Neuroradio-logical imaging will show an enlarged sella with intrasellar bleeding and/or necrosis.

Internal carotid artery (supradinoid)

Internal carotid artery (supradinoid)

Dura mater

Pituitary Gland Carotid Artery

Pituitary gland

Internal carotid artery (intracavernous)

Mucosa of the sphenoid sinus

Trabeculae of the cavernous sinus

Body of the sphenoid bone

Pituitary gland

Ophthalmic division of the trigeminal nerve

Maxillary division of the trigeminal nerve

Dura mater

Body of the sphenoid bone

Internal carotid artery (intracavernous)

Mucosa of the sphenoid sinus

Trabeculae of the cavernous sinus

Fig. 10.11. Coronal section through the left cavernous sinus. Within this 2-cm long venous sinus to each side of the sphenoid sinus are the courses of all three ocular motor nerves, the internal carotid artery with its surrounding sympathetic plexus, and the first and second branches of the trigeminal nerve. The supraclinoid carotid barely makes contact with the optic nerve. All inflammatory or mass lesions within the cavernous sinus or in neighboring structures (pituitary gland, petrous apex, nasopharynx) cause both sensory and motor deficits, due to the closely crowded positions of these structures. For combined deficits (e.g., third and sixth nerve pareses) the cavernous sinus is the probable location of the lesion. (Redrawn after: Sobotta, J., Becher, H.: Atlas der Anatomie des Menschen, Chap. 3, Fig. 238. Urban & Schwarzenberg, M√ľnchen, Berlin 1962)

Another acute presentation of combined oculomotor pareses can (infrequently) be caused by rupture of an intracavernous carotid aneurysm. This invariably results in a pulsating proptosis with an arteriovenous fistula that has a very high volumetric flow rate. The changes in the eye's mo-tility are consequently at least partially caused by changes in the mechanical properties of the orbital tissues.

The signs and symptoms of a traumatic fistula following injury to the internal carotid artery within the cavernous sinus will slowly progress for a period of several weeks, ending in a severe, pulsating exophthalmos that threatens to destroy vision, usually (but not always) on the ipsilateral side. In addition to the ocular signs of a direct, high-flow arteriovenous fistula, there is also a major threat of cerebral ischemia, a steal phenomenon caused by short-circuiting of arterial blood into the venous sinuses.

Was this article helpful?

0 0
101 Power Tips For Preventing and Treating Headaches

101 Power Tips For Preventing and Treating Headaches

Are you fed up with your frequent headache pain? 101 Simple Ways to Attack Your Headache BEFORE the Pain Starts Guaranteed No Pain, No Fear, Full Control Normal Life Again Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.

Get My Free Ebook


Post a comment