A woman aged 52 years presented with episodic holocranial headaches with recurrent episodes of diminution of vision in the right eye and decreased sensation on the right side of face for the past 1 year. Clinical examination revealed optic atrophy in the right eye and sensory loss on the ophthalmic and maxillary division of the trigeminal nerve. MRI brain revealed extensive nodular enhancement on T1-weighted contrast images predominantly involving the dura around bilateral temporal lobes, right fronto-basal area and bilateral cavernous sinuses (figure 1). CT scan of the chest showed multiple lung nodules and mediastinal lymphadenopathy. Cerebrospinal fluid examination, cryptococcal antigen, vasculitic screen, HIV serology and serum ACE levels were all in normal range.
MRI brain, axial section, T1-weighted image showing contrast enhancement involving the dura around bilateral temporal lobes, right fronto-basal area and bilateral cavernous sinuses.