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A 58-year-old immunocompetent woman gave a 2-week history of headache, facial pain and fever, without photophobia, nausea or vomiting. Initially, the pain was left-sided retrobulbar and radiated to the vertex. It was dull and intermittent without postural variation but progressively intensified, becoming more constant with nocturnal interference. The pain gradually extended bilaterally to the cheeks, maxillae and frontoparietal regions while remaining predominantly left-sided. Two days before assessment, she had developed horizontal diplopia on left lateral gaze. On examination, her temperature was 38.5°C, and there was limited left eye abduction consistent with left sixth nerve palsy. Her other cranial and peripheral nerve function, ears, nose and throat were normal with no signs of meningeal irritation. Blood tests (including blood cultures) were negative. CT scan of the head identified left sphenoid sinus opacification (figure 1A,B; black arrows) with …
Contributors All authors contributed to the clinical care of the patient, wrote and reviewed the manuscript, and approved its final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed by Neil Anderson, Auckland, New Zealand.