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Pituitary apoplexy causing thunderclap headache: easy to miss
  1. Jon Equiza1,
  2. Jon Rodríguez-Antigüedad1,
  3. David Campo-Caballero1,
  4. Pablo Iruzubieta Agudo1,
  5. Marta Ruibal1,
  6. Patricia de la Riva1,
  7. Eñaut Garmendia2,
  8. Ane Mínguez-Olaondo1
  1. 1 Neurology Department, Donostia University Hospital, San Sebastian, Spain
  2. 2 Interventional Neuroradiology Section, Radiology Department, Donostia University Hospital, San Sebastian, Spain
  1. Correspondence to Jon Equiza, Neurology Department, Donostia University Hospital, Paseo Dr Begiristain, 109, Donostia-San Sebastian 20014, Spain; jon.equizabazan{at}

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An 82-year-old man developed a sudden onset headache with nausea and vomiting. The pain was severe and diffuse, reaching its maximum intensity in less than 1 min, and was refractory to simple analgesia. There was no history of headache. He was already in hospital following a pulmonary embolism and had a history of hypertension, coronary artery disease and atrial flutter. He had previously taken dual antiplatelet therapy but had recently switched to single antiplatelet therapy and unfractionated heparin because of the pulmonary embolism. His initial CT scan of head was reported as normal (figure 1).

Figure 1

CT scan of head (initially reported as normal). (A and B) Initial image: Sellar mass with patchy hyperdensity. (C and D) Repeated image with CT angiography. This excluded an aneurysm; there is …

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  • Acknowledgements We thank the patient for his cooperation.

  • Contributors All authors made substantial contributions to the conception of the work, data acquisition, drafting the work and revising it for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Consent obtained directly from patient(s).

  • Ethics approval Not applicable.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Stuart Weatherby, Plymouth, UK and Nicola Giffin, Bath, UK.

  • Data availability statement There are no additional unpublished data from the study.

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    Phil E M Smith Geraint N Fuller

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