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Case 22

Painful proptosis in a young woman

This woman presented in her thirties with a short history of painful swelling of the left eye. This had been present for only a few days. Her vision was intact but the eye was congested on examination and slight proptosis was present.

An MRI was performed to assess her further. Some sample images are presented

• axial T2 weighted images of the brain
• coronal STIR images of the orbits
• coronal T1 weighted images of the orbits pre and post contrast

What is responsible for her pain and swelling? What is the liabnormality kely diagnosis? What is the appropriate treatment?

What other abnormality is present, and do you think it is related?