Hiding and Out of Sight

A 75-year-old white woman presented with a history of biopsy-proven giant cell arteritis (GCA) presented with recurrence of severe left sided headaches and left global ophthalmoparesis for 4 days. GCA had been diagnosed 4 months prior by biopsy. Left eye vision loss occurred when an outside physician tapered corticosteroid therapy 5 weeks into her illness. MRI 5 weeks into her illness showed enhancement of the left orbital apex, adjacent temporal dura and neighboring cavernous sinus. Dural biopsy at that time was normal, and a second temporal artery biopsy performed then confirmed GCA. Examination was remarkable for left eye vision loss to no light perception with an amaurotic pupil and global left ophthalmoparesis including ptosis and pupil involvement with a normal fundus. Repeat MRI showed progression of the prior lesions. A diagnostic procedure was performed