Young patient with headache, fever and blurred vision

Abstract

Background and importance. This case highlights that acute pituitary apoplexy is possible to be confused and misdiagnosed with other entities with similar symptoms, such as meningitis or subarachnoid hemorrhage. Clinical presentation. A young patient presented with sudden and severe frontal headache, fever, blurred vision, nausea, confusion, as well as oculomotor palsy (CN III) with partial ptosis of the left eyelid, dilated left pupil and left eye globe deviation inferiorly and laterally. The final diagnosis was acute pituitary apoplexy complicating a pituitary macroadenoma. In this setting, headache is usually present due to stretching and irritation of the dura mater, while fever due to meningeal irritation or upward expansion leading to hypothalamic dysfunction. Decreased visual acuity and defects in visual fields are caused by upward expansion, which compresses the optic chiasm. Ophthalmoplegia can also be observed due to lateral expansion with invasion of the cavernous sinus. Conclusion. Medical professionals involved in the care of emergencies should be aware of this clinical entity and collaborate with endocrinologists during a multidisciplinary team approach for prompt diagnosis and appropriate treatment of such patients.