Author: Natasha Dole / Editor: Thomas MacMahon / Reviewer: Rafeeq Ahmed Sulaiman / Codes: EnC5, IP1, NeuC6, NeuP2, NeuP7, RP6, SLO3 / Published: 25/02/2023

A 77-year-old gentleman presents to the Emergency Department (ED) five days after his endoscopic endonasal transsphenoid resection of his pituitary adenoma with a severe frontal headache and multiple episodes of significant vomiting. His symptoms started two days ago shortly after discharge from an uncomplicated hospital stay.

He describes the headache as constant and throbbing with a pain severity of 8 out of 10, exacerbated by movement, with associated fever, rigors and blurred vision.

He is now retired with a background history of well controlled hypertension, gastro-oesophageal reflux disease and hypothyroidism, with recently added regular oral steroid following his surgery. On examination, he has a temperature of 39oC with a heart rate of 130 bpm and a blood pressure of 90/50 mmHg.

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