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 Best of Five 2.83

 

   

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BOF: 2.83

 

A 52-year-old male presents with severe headache, nausea and vomiting.  He also complains of double vision. On examination, he was afebrile, his pulse rate was 120 beats per minute and his blood pressure was 85/50. There was a complete ptosis of his right eye and the right pupil was dilated and the eye was deviated inferiorly and laterally.  There was neck stiffness.

Investigations:

 

Hb 14.2 g/dL
WCC 15.2
Na 120 mmol/l (137-144 mmol/L)
K 5.3 mmol/L (3.5-4.9 mmol/L)
TSH 1.0 mU/L (0.4-5 mU/L)
Free T4 6 pmol/L (10-22 pmol/L)
Serum cortisol 150 nmol/L (200-700 nmol/L)

In this patient which one of the following conditions is most likely?


a) Meningitis

b) Cavernous sinus thrombosis
c) Pituitary apoplexy
d) Subarachnoid haemorrhage
e) Brain stem stroke

 

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