ABSTRACT
Headache during pregnancy is a common complaint in the emergency room. In pregnancy, pituitary disorders include both hormone active and hormone inactive tumors. Apoplexy may be the first clinical presentation of an underlying pituitary tumor. Red flag signs of presenting symptoms, to be assessed for identifying life-threatening etiology. Various pathophysiological mechanisms have been passed for pituitary apoplexy in pregnancy. Magnetic resonance imaging of the brain is the gold standard investigation. The mainstay of management is the initiation of steroids. Transnasal transsphenoidal removal of the tumor is the definitive treatment that requires a multidisciplinary approach. The indications of surgery are the presence of symptoms due to compression and endocrine abnormalities; however, gestational period should be taken into consideration. We report a case of headache in antenatal women who presented to our emergency room diagnosed with pituitary apoplexy managed with steroids and early surgery, and discharged with good clinical outcome. We recommend a methodical approach to common symptoms that assist in diagnosing forgotten etiology.
ABSTRACT
Inferior wall myocardial infarction (MI) is one of the common straightforward cardiac conditions in the emergency department (ED) but inferior wall MI masquerading pulmonary embolism (PE) is extremely rare and can be missed if not evaluated promptly in ED. Misdiagnosis of PE is associated with high mortality. Here, we report a case of a 67-year-old male who was admitted to the ED and has been diagnosed with evolved inferior wall MI based on his clinical presentation and electrocardiogram. Later, he developed syncope following which he was reassessed and evaluated for the other possible conditions. Bedside echocardiography findings raised suspicion for PE, which was further confirmed by computed tomography pulmonary angiogram (CTPA). The patient underwent successful thrombolysis and was scheduled for an elective coronary angiogram. This case report highlights the importance of clinical presentation and the benefits of bedside echocardiography that helped in suspecting the association of PE with evolved inferior wall MI