Elderly woman presents with rapidly progressive bilateral ophthalmoplegia and blindness

An 80-year-old woman was transferred from an outside hospital to the emergency department at Tufts Medical Center for ophthalmological evaluation around midnight. In a matter of hours, she had developed bilateral, progressive ophthalmoplegia and complete vision loss. She endorsed worsening “swelling” of the left upper eyelid and numbness around the left eye and cheek for the past 2 days. She also reported a 1-week history of pain in the left forehead and temple, as though her jaw felt “locked.” Her primary care physician had recently discovered ethmoidal and sphenoidal