A 55-year-old woman presented to the emergency department (ED) with the chief complaint of headache for three days, associated with nausea, vomiting, and visual changes. The headache was described as being sudden in onset, constant, bilateral, retro-orbital, and throbbing. The pain was a six out of ten in intensity. The pain was not alleviated with over the counter acetaminophen use. She was not able to describe any alleviating or exacerbating factors. The visual changes were described by the patient as “blurry vision” and “double vision” affecting her left eye greater than her right. She reported photophobia and difficulty keeping the left eye open. The patient described this difficulty of keeping the eye open as a weakness and not secondary to pain. She had approximately five episodes of non-bloody and non-bilious vomiting over the past three days and reported inability to tolerate her home medications. She also reported a sore throat and cough productive of yellow sputum for the previous two to three days, but denied fever, chills, chest pain, hemoptysis, or dyspnea. Her past medical history included essential hypertension, hyperlipidemia, and a remote history of uterine fibroids associated with iron deficiency anemia. Prescribed medications included losartan 25 milligrams (mg) and hydrochlorothiazide 12.5 mg. She had no known drug allergies, did not smoke, drink alcohol, or use illicit drugs. She was unemployed and lived alone. The patient was post-menopausal and was pregnant three times-two of which were normal spontaneous deliveries with two living children and one prior abortion. Vital signs were: temperature 98.8° Fahrenheit, heart rate 84 beats per minute, blood pressure 135/74 millimeters of mercury, respiratory rate of 18 breaths per minute and room air oxygen saturation 97%. Her body mass index was 42 (normal 18.5–24.9). Complete physical examination was unremarkable except her left eye’s lateral gaze was restricted by approximately 25%. Her visual acuity was 20/25 and 20/30, right and left eyes, respectively. Initial laboratory testing were resulted ( and ). An electrocardiogram was performed ().