case_images: PMC9902052_01
case_images: CT imaging of the head. CT of the head showed no evidence of hemorrhage, no mass effect, normal attenuation characteristics of the brain parenchyma, and ventricles normal for age. (A) Transverse CT imaging showing the bilateral orbits. (B) Sagittal CT imaging showing the right orbit. (C) Coronal CT imaging showing the bilateral orbits. (D) Transverse CT imaging showing the normal ventricles. CT: computed tomography
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case_images: FIG1
case_images: Given the patient's presentation, she underwent further evaluation with computed tomography (CT) imaging, which showed no acute intracranial findings or evidence of orbital trauma (Figure 1).
case_images: MRA imaging of the neck. (A) Coronal MRA imaging showing the bilateral carotid arteries and all the major branching arteries of the neck. (B) Sagittal MRA imaging showing the carotid arteries and the vertebral arteries. Both common carotid and internal carotid arteries are widely patent. No significant atherosclerosis or stenosis at the carotid bifurcations upon NASCET criteria. The left vertebral artery is dominant. Both vertebral arteries are patent without focal stenosis. There is no significant stenosis in the cervical carotid and vertebral arteries as seen in the figure. MRA, magnetic resonance angiography; NASCET, North American Symptomatic Carotid Endarterectomy Trial
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case_images: FIG2
case_images: The magnetic resonance angiography (MRA) of the head and neck alongside the MRI of the brain was also unremarkable (Figures 2-3).
case_images: MRA imaging of the head. (A) Transverse MRA imaging showing the circle of Willis. (B) Anterior-posterior MRA imaging showing the sagittal view of the circle of Willis. (C) Coronal MRA imaging showing the anterior view of the circle of Willis. (D) Detailed MRA imaging of the circle of Willis in the sagittal view, highlighting all the tributary arteries leading to the ophthalmic artery. The distal internal carotid, anterior, and middle cerebral arteries are widely patent. The distal vertebral arteries, basilar artery, and posterior cerebral arteries are widely patent. There is no evidence of aneurysm or focal stenosis. The image displays an unremarkable MRA of the head. MRA: magnetic resonance angiography
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case_images: FIG3
case_images: The magnetic resonance angiography (MRA) of the head and neck alongside the MRI of the brain was also unremarkable (Figures 2-3).
case_images: MRI imaging of the head. The image shows that the right globe is intact, but there is mild right exotropia present. Subtle edema is present along the superior and lateral contour of the preseptal right orbit, which is best appreciated in the axial STIR images (A). There is a suspected mild extension of edema into the extraconal postseptal fat as in the coronal STIR image (C). Additional STIR signal abnormality with associated mild postcontrast enhancement is present along the posterior contour of the globe lateral to the optic nerve (A). There is mild asymmetric dilation of the right optic nerve sheath with flattening of the optic disc. There is suspected subtle hyperenhancement of the right optic nerve sheath as in the coronal image (B) immediately posterior to the globe. Abnormal T2 hyperintensity and hyperenhancement are present in the right superior and medial rectus muscles best seen in the coronal STIR image (C) and coronal postcontrast image (B). There is no drainable abscess identified, and no pathologic signal or pathologic enhancement is detected in the optic nerve proper. The cavernous sinuses enhance symmetrically. STIR: short TI inversion recovery
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case_images: FIG4
case_images: The MRI of the orbits showed an unusual spectrum of signal abnormalities predominantly involving the preseptal right orbit but with the involvement of several intraorbital structures as described, including the posterior contour of the right globe, extraocular musculature, and optic nerve sheath (Figure 4).
case_images: Macular thickness measured in spectral domain optical coherence tomography (SD-OCT). RPE, retinal pigment epithelium; ILM, internal limiting membrane
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case_images: FIG5
case_images: During the patient's follow-up visit, it was noted that she had retinal pigment epithelial atrophy but no evidence of a macular hole or edema (Figure 5).
case_images: The ophthalmic artery and its branches. Source: Haggstrom M: Medical gallery of Mikael Haggstrom 2014. Wiki J Med. 2014, 1:1-53. 10.15347/wjm/2014.008
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case_images: FIG6
case_images: The ocular group includes the long posterior ciliary arteries, short posterior ciliary arteries, anterior ciliary artery, central retinal artery, superior muscular artery, and inferior muscular artery (Figure 6).