Headache, vomiting and diplopia.

Accepted 17 July 1996 A 47-year-old woman was admitted to the hospital with a history of sudden headache, vomiting and slight diplopia on left lateral gaze, without alteration in the level of consciousness. The patient had been diagnosed as suffering from stage II breast cancer, 10 months earlier, after detection of a 2-cm mass in the left breast. A total mastectomy and axillary dissection was performed. Pathological examination revealed an invasive ductal carcinoma without axillary involvement. Tamoxifen and adjuvant chemotherapy with cyclophosphamide, 5-fluorouracil and methotrexate was administered. On physical examination the patient appeared well. Blood pressure was 90/60 mmHg. No lymphadenopathy was found. Examination of the gastrointestinal, respiratory and cardiovascular system was unremarkable. Neurological examination showed bitemporal hemianopsia and a complete third cranial nerve palsy on the left side. Findings on haematology, urine analysis, serum chemistry, electrocardiography and chest Xray were normal. Hypothalamic and pituitary function tests show deficiency of adrenocorticotropin, thyroid-stimulating hormone, growth hormone, luteinising hormone and prolactin. Cranial magnetic resonance imaging (MRI) was performed (figure). Staging work-up including bone scan and adbominal ultrasound did not disclose metastatic lesions.