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A 26-Year-Old Man Is Brought to the Emergency Department Due

question 199

Multiple Choice

A 26-year-old man is brought to the emergency department due to a severe headache that started 2 hours ago and has steadily become worse. The patient says the pain is dull, diffuse, and associated with nausea, vomiting, lightheadedness, and blurred vision. Medical history is unremarkable, although he is currently being evaluated for loss of libido and erectile dysfunction. A week ago, laboratory results showed low testosterone, low gonadotropins, and high prolactin levels; TSH and free T4 were normal. The patient does not use tobacco, alcohol, or illicit drugs.
Temperature is 36.7 C (98 F) , blood pressure is 80/50 mm Hg, and pulse is 114/min. He is diaphoretic and appears to be in significant distress, although he is awake and oriented to time, place, and person. Pupils are 4 mm, symmetric, and reactive to light. There is ptosis of the right eyelid and decreased adduction of the right eyeball on left gaze. Visual field examination on confrontation shows bitemporal visual field defects. There is no nuchal rigidity. The remainder of the examination is unremarkable.
Laboratory results are as follows:
What is the most appropriate immediate next step in management of this patient?

Definitions:

Cuboidal Epithelium

Cuboidal epithelium consists of cube-shaped cells with a central nucleus, found lining various glands and ducts, playing a role in secretion and absorption.

Stratified Epithelium

A type of epithelial tissue composed of several layers of cells, providing protection against mechanical and chemical stress.

Pseudostratified

Describes epithelial tissue that appears to be layered but all cells actually reach the basal surface, giving a deceptive appearance of stratification.

Transitional

Referring to a phase or state that is changing or evolving from one form or condition to another, often used in contexts such as transitional economies or transitional epithelium.