Clinical Reasoning: A 60-Year-Old Woman With Fever, Headache, Diplopia, and Unilateral Periorbital Swelling.
Naijimiding Rexiati, Shihao Jiang, Aximujiang Axier et al.
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Case in brief
A 60-year-old woman presented with fever, headache, horizontal diplopia, and unilateral periorbital swelling after experiencing recurrent gingival swelling and pain for about a month. Examination revealed a left abduction deficit and conjunctival chemosis. Cerebral angiography showed severe narrowing of the cavernous segment of the internal carotid artery. The patient improved with antimicrobial therapy, but follow-up imaging a year later revealed a new vascular lesion.
Diagnostic / clinical pearl
Clinicians should consider interval neurovascular follow-up imaging in patients with cavernous internal carotid artery abnormalities, especially when presenting with febrile ophthalmoplegia.