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A 68-year-old man with metastatic prostate cancer was admitted with a 1-week history of bilateral ‘conjunctivitis’, headaches and horizontal diplopia. On examination, the superficial temporal arteries were bilaterally prominent and indurated, with conjunctival injection and chemosis. There were bilateral abduction deficits, but visual acuity and fundi were normal.
MR scan of the brain and orbits showed bilateral enhancement of the temporal arteries with intraconal fat stranding but with no extra-ocular muscle enlargement or orbital mass (figure 1A,B). His erythrocyte sedimentation rate was elevated at 103 mm/1st h (<20), serum C reactive protein was 14 mg/L (<10) and CSF: …