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A 7-year-old girl was referred to the emergency department for diplopia. She had a 3-week history of frontal headaches and asthenia, a 6-month history of cranial trauma with loss of consciousness, and a 1-month history of insect bites with impetiginization of the left elbow and mandibula. Her temperature was not elevated, and there was no evidence of a meningeal syndrome. Oculomotor examination revealed paralysis and abduction of the right eye (Figure 1, looking to the right). Otoscopic examination demonstrated a dull tympanic membrane, with no sign of acute otitis media. There was no facial paralysis or vestibular syndrome. The results of laboratory tests were normal except for the C-reactive protein level, which was 30 mg/L (to convert to nanomoles per liter, multiply by 9.524).
Hitier M, Boutet C, Faure C, Abadie C, Moreau S. Radiology Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2010;136(2):201. doi:10.1001/archoto.2009.218-a