Pituitary apoplexy presenting as a thunderclap headache

Abstract

Pituitary apoplexy is an uncommon clinical syndrome characterized by acute headache, ophthalmoplegia, diminished visual acuity, and altered mental status caused by the sudden hemorrhage or infarction of a pituitary gland that invariably harbors an adenoma. This case highlights the variability in presentation and underscores the need for a high index of suspicion and the need for MRI in patients presenting with thunderclap headache and normal initial investigations. Case report. While eating dinner, this 50-year-old woman was thunderstruck by an intense headache, nausea, and recurrent vomiting. She visited a local emergency ward on the second and fifth day of her illness. Injections of meperidine and ketorolac were given, but no investigations were done and no diagnosis was rendered. The patient's family physician saw her on the third day of her illness and obtained a CT of the brain, which was interpreted as normal. She developed ptosis of the right lid and diplopia 4 days …