To the Editor.
—Transient oculomotor nerve misdirection has been reported in ophthalmoplegic migraine, with complete resolution occurring within three months.1 We present a patient who had an acute onset of oculomotor nerve paresis, concurrent oculomotor nerve misdirection, and complete resolution of misdirection within ten days. We believe that in our patient, acute hemorrhage in the pituitary tumor was the inciting event for the acute oculomotor nerve palsy and misdirection. Peripheral ephaptic transmission is believed to be the most likely mechanism for the transient oculomotor nerve misdirection.
Report of a Case.
—A 70-year-old man presented with a sudden onset of right blepharoptosis, horizontal diplopia, and bifrontal headache. His visual acuity and visual fields were normal. The right pupil reacted sluggishly to light and was 1 mm larger than the left pupil. A right upper eyelid ptosis was present. Supraduction and infraduction of the right eye were moderately reduced, while adduction
Johnson LN, Pack WL. Transient Oculomotor Nerve Misdirection in a Case of Pituitary Tumor With Hemorrhage. Arch Ophthalmol. 1988;106(5):584–585. doi:10.1001/archopht.1988.01060130634010