MRCP2-3345

MRCP2-3345

A 20-year-old woman presents to her clinic appointment in distress. She has been experiencing severe headaches for the past year, causing her to drop out of her university studies. The headaches are debilitating and often prevent her from doing anything else. She experiences vomiting most days of the week when the pain is at its worst, and her vision feels blurry. Despite trying sumatriptan, NSAIDs, paracetamol, and relaxation techniques, her GP has been unable to provide much relief. She is currently taking sertraline for depression and does not smoke.

The patient’s headaches are a constant, severe frontal headache with radiation around the eyes. She can vomit at times, often before breakfast. She has rarely found relief from her symptoms, but notes that they are better in the evenings.

On examination, the patient has normal visual fields, equal limb strength, and normal tone. There is no sensory loss. Her fundi show no bleeds or exudate, but the disc is blurred. She has a raised body mass index of 26kg/m² and is afebrile. There is no sinus tenderness, and no inflammation of the upper respiratory tract mucosa can be seen.

Her blood work shows:
– Na+ 138 mmol/l
– K+ 4.3 mmol/l
– Urea 5.1 mmol/l
– Creatinine 87 µmol/l

A CT scan of her head shows no intracranial haemorrhage, mass effect, or lesions seen. However, an MRI scan shows flattening of the sclera of the eye, partially empty sella turcica, and an enlarged subarachnoid space around the oculomotor and optic nerves.

What is the likely diagnosis?