You are examining Alice Smith (with ?acromegaly).
How can a pituitary tumor affect the cranial nerves (list two mechanisms)? What cranial nerves can be affected?
Upward growth – affects the optic chiasm:
- Cranial nerve II
Lateral growth into the cavernous sinuses:
- Cranial nerves III, IV, V1, V2, VI
How do you examine the patient for damage to these nerves?
Cranial nerve II:
- visual acuity
- visual fields (including red pin) looking for bitemporal hemianopsia
- PERLA (looking for RAPD)
- fundoscopy (R/O optic disc pallor)
Cranial nerves III, IV, VI:
- EOMS (diplopia)
Cranial nerve V1, V2:
- sensation forehead and cheek
- corneal reflex
