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A 16-year-old girl presented with a 3-month history of worsening right temporal and retroauricular headaches. She had previously been treated for otitis media with antibiotics, but her headache and pain continued to increase. Later, she developed an ataxic gait, increasing somnolence, vomiting and diplopia that prompted admission to hospital. On examination, she was also noticed to have right third-division trigeminal neuralgic pain and rightsided dysmetria on finger to nose testing.