Case study: acute onset frontal headache
The left eye was completely shut but not proptosed and the pupil was unresponsive to all modalities... Do you know the answer?
Presentation: A 69-year old former office worker presented to the emergency department with acute onset frontal headache that reached its peak in 30 seconds. The left eye was completely shut but not proptosed and the pupil was unresponsive to all modalities. There was nausea, moderate neck stiffness and pyrexia. Acuity in the left eye was reduced to counting fingers and the right upper temporal field was reduced to confrontation.
Past history: chronic obstructive pulmonary disease. Myocardial infarction 10 years previously. Hypertension was well controlled and raised cholesterol.
What is the most likely diagnosis?:
Giant anterior communicating artery aneurysm
Pituitary apoplexy
Giant cell arteritis
Acute sphenoid sinus infection
Cavernous sinus thrombosis