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Case Report: Headache and Ptosis

Check out our latest case report. This report features a man in his 60s presenting to the ED complaining of vomiting a pulsating left-sided headache.

Case Report:

A man in his 60s presents to the emergency department for 24 hours of vomiting and pulsatile left-sided headache that has been associated with some blurred vision that he is not great at describing. He went online and read it could be a migraine and should get better within 24 hours so he waited. It didn’t get better so he came to the hospital. He denies any weakness, fever, vomiting, balance problems or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for a pulse of 44. Exam was impressive and was normal except for dramatic left-sided ptosis with the eyelid drooping past the pupil. There was also a disconjugate gave with difficulty moving the left eye medially or superiorly

A CT of the head was performed:

What is the most likely diagnosis?

  1. Brain aneurysm
  2. Carotid dissection
  3. Pituitary apoplexy
  4. Complex migraine