Patient aged around 50 yrs presented to old with complaints of severe headache for the past 4 days,nausea and vomiting occasionally, not a k/c/o dm ,sht,alcoholic ,smoker,,,bp 140 over 90 mmHg,PR 82 BPM .ct brain has been taken it shows..kindly diagnose !

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Dear Dr. Amarnath P, Basically you are dealing with a case of ICSOL causing compression on right third cranial nerve producing right sided ptosis. Severe headache, nausea and vomiting is due to increased intracranial pressure. Did u enquire about diplopia? What about the pupil size? 1) Ptosis with dilated pupil: Compressive pathology by a SOL. 2) Ptosis with normal size pupil: Diabetes Mellitus 3) Ptosis with constricted pupil: Horner's syndrome. Thanking you for a good case.

As it's a short history , acute presentation most probably of vascular origin, could be an aneurysm compressing upon right oculomotor nerve.
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The mass is entirely sellar and hardly has a suprasellar component. Pcom aneurysms are almost never midline . There is irregular parenchyma and it is going into the cavernous sinus or atleast pushing it on the right side which is the probable cause for the third nerve affliction. The aneurysms of suprclinoid portion of internal carotid artery are much rarer compared to the Acom aneurysms and will not be dead centre like this.

can it be pitutary apoplexy
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The patient has a right ptosis, suggestive of third cranial nerve involvement and the CR scan shows a sellar mass. MRI will help to pinpoint the nature amongst the differential diagnoses of sellar mass. Further treatment will be dictated by the finding on MRI Brain with contrast including pituitary protocol .

possibility of - suprasellar mass lesion pituitary macro adenoma rt.ica supraclinoid aneurysm. clinically we have to see pupils involvement or pupils sparing. rt.supraorbital apex syndrome. could be mass is incidental finding.

When a mass is seen on the scan, ophthalmological causes are ruled out. Other than perimetry to have a baseline field record, detailed work up of eyes is not likely to be of help.

classical case of 3rd. Cranial nerve palsy. .. do MRI Brain to r/o SOL... rest neurologist opinion

right third nerve palsy. ..?SOL

3 nerve palsy

NCCT brain shows hyperdensewell rounded lesion in the sellar area with supra sellar extension.pt has rt sided ptosis and the pupil is coverted 1/ 3rd only suggestive of partial ptosis. Pupil size is very important to decide 3rd nerve or horners syndrome. BLEED in the pituitary vs Aneurysm arising from supraclinoid internal carotid artery. Suggest angiogram.

need detailed history about nature of pain , recurrence, aggravating factors, giddiness , trauma etc. but if not responding to conservative treatment GI for CT brain

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