A 53-year-old female presented with a 4-month history of left periorbital headache and frontal parasthesia. Imaging showed a 1cm enhancing lesion in the cavernous sinus. She was initially treated for tuberculosis but did not improve. Further workup revealed positive Mantoux test but negative CSF studies. Her symptoms improved 90% with a short course of antibiotics and steroids. The differential diagnosis includes cavernous sinus syndrome such as Tolosa-Hunt syndrome, an idiopathic inflammatory condition. A repeat MRI after treatment showed reduction in the size of the lesion, consistent with inflammatory pseudotumor.