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Sudden Headache And Vision Loss
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45M, Headache, vomiting, sudden vision loss and suprasellar mass
Initial Imaging
Walking Thoughts
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What is the patient’s neurological exam?
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What are the patient’s vitals?
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Does the patient have a known pituitary adenoma or suprasellar mass?
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Are his symptoms related to the suprasellar mass or is the suprasellar mass an incidental finding (e.g. rule out stroke, elevated intracranial pressure)?
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Is the mass causing hydrocephalus?
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What is the timeline for his symptoms?
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Will the patient require any immediate hormone replacement? What is the patient’s sodium level? Is the patient hypotensive?
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Does this patient need emergent surgery?
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What are the patient’s medical comorbidities?
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Is the patient on antiplatelet or anticoagulant medications?
History of Present Illness
A 45 year old male with no significant past medical history presents to the emergency department complaining of 3 days of progressively worsening headache with associated emesis and now 12 hours of blurry vision with peripheral vision loss. He reports that he also has been having both heat and cold sensitivity and overall fatigue over the past few months. He did not see a doctor for these symptoms and the suprasellar mass seen on CT here in the ED is a new finding. He denies any focal weakness, numbness, tingling, or speech difficulties. He is not on any anticoagulant or antiplatelet medications.
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