A 56-year-old man with uncontrolled diabetes and hypertension was hospitalized on June 18, 2011, for excruciating right facial pain and decreased hearing for 1 month. The results of an initial ophthalmic examination were unremarkable, but 1 week later, his visual acuity was NLP OD with total ophthalmoplegia. Ptosis of the right eye and a small nonreactive right pupil were present, with no optic disc edema in either eye. Sensation of the right face was decreased 50% and was worse in the second and third trigeminal divisions. The muscles of mastication were atrophic on the right. The patient had difficulty chewing, and his smile was asymmetric. He developed severe pharyngeal dysphagia, an ineffective cough reflex, and an inability to swallow, which led to the placement of a percutaneous endoscopic gastrotomy tube. In all, there was right optic neuropathy with ipsilateral palsy of the cranial nerves III through XII. The results of an MRI revealed leptomeningeal enhancement of the right temporal skull base and a cavernous sinus extending through the foramen ovale into the infratemporal fossa (Figure 2).