Pituitary adenoma presenting as painful intermittent third nerve palsy

We report the case of a woman with short nocturnal attacks of peri- and retro-orbital pain, diplopia, ptosis, rhinorrhea and lacrimation of five months evolution. Neurological examination was normal between attacks. The latter presented with partial third nerve palsy, which finally became complete and permanent. Brain CT showed a sellar and supraseller tumor with parasellar extension to the right side. We stress the atypical clinical presentation and evolution of this case, and discuss its pathophysiology.