Emergency Med Case Challenge: A 41-Year-Old on Sildenafil With a Headache While Sleeping

Mousa Abujbara, MD


August 22, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 41-year-old man presents to the emergency department (ED) with a severe frontal headache that began suddenly and awakened him from sleep. The headache is associated with nausea, vomiting, and subjective fevers. He also complains of new-onset diplopia and photophobia but denies any decrease in visual acuity. He denies experiencing any associated seizures, focal weaknesses, previous similar episodes, frequent headaches, or previous visual disturbances.

He does not have any prior significant medical problems, and his only medication is occasional sildenafil. He drinks socially, does not smoke, and does not engage in recreational drug use.


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