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JAMA Neurology Clinical Challenge |

Keeping an Eye on This Headache QUIZ

Matthias Hoheisel, MD1,2; Matthias Sturzenegger, MD1; Niklaus Meier, MD1
[+] Author Affiliations
1Department of Neurology, Inselspital, University Hospital Berne and University of Berne, Switzerland
2Department of Neurology, Schlosspark-Klinik, Berlin, Germany
JAMA Neurol. 2016;73(6):751-752. doi:10.1001/jamaneurol.2016.0346.
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A 24-year-old woman had a strong unilateral headache located in her left cheek, eye, and forehead that evolved during the evening hours, peaked at night, and decreased again until the morning, without any remarkable trigger along with ipsilateral lacrimation, a red eye, and periorbital swelling but without ptosis. What is your diagnosis?

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Figure 1.

The patient during the first pain episode, with a red left eye, lacrimation, and periorbital swelling.

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Figure 2.

T1 axial (A) and coronal fluid-attenuated inversion recovery (FLAIR) (B) magnetic resonance imaging, showing a mucus-rich (with relative high intensity on T1) bulging mucocele of the left nasal cavity (arrowheads).

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