One week later, visual acuities improved to 20/40 OD and counting fingers at 4 ft OS, and the intensity of the headaches decreased. Oral prednisone was tapered from 80 mg/d to 20 mg/d over 5 days. On the sixth day, when the patient received 20 mg of prednisone, she developed a worsening headache and decreased responsiveness. She was admitted to a tertiary care academic hospital, where she developed respiratory distress and was intubated. A helically acquired axial computed tomographic scan of the brain without contrast with 5-mm slices showed extensive multifocal cortical infarcts, a 7-mm midline shift, and tonsillar herniation, which contraindicated lumbar puncture for cerebrospinal fluid analysis. Despite receiving 1 g of intravenous methylprednisolone sodium succinate daily for 3 days, she died. Autopsy was refused.