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Fontani E, Branda E, Denina M, Baroero L, Canavese C, Mignone F, Giordano P, Conrieri M, Versace A, Bondone C. Abducens nerve palsy in a young girl with otorrhea: A case of Gradenigo's syndrome. Pediatr Neonatol 2024:S1875-9572(24)00114-1. [PMID: 39004540 DOI: 10.1016/j.pedneo.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Eleonora Fontani
- Department of Pediatrics and Public Health, Regina Margherita Children's Hospital, Turin, Italy
| | - Elena Branda
- Department of Pediatrics and Public Health, Regina Margherita Children's Hospital, Turin, Italy
| | - Marco Denina
- Infectious disease unit, Department of Pediatrics, Regina Margherita Children's Hospital, Turin, Italy; Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy.
| | - Luca Baroero
- Department of Pediatrics, Martini Hospital, Turin, Italy
| | - Carlotta Canavese
- Pediatric neurology unit, Department of Pediatrics, Regina Margherita Pediatric Children's, Turin, Italy
| | - Federica Mignone
- Infectious disease unit, Department of Pediatrics, Regina Margherita Children's Hospital, Turin, Italy
| | - Pamela Giordano
- Pediatric Otorhinolaryngology, Department of Pediatrics, Regina Margherita Children's Hospital, Turin, Italy
| | - Margherita Conrieri
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
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Mammarella F, Loperfido A, Velletrani G, Casorati F, Stasolla A, Di Girolamo S, Bellocchi G. Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo's Syndrome: Early Dysphagia and Late Abducens Nerve Palsy. J Med Cases 2024; 15:43-48. [PMID: 38646423 PMCID: PMC11027766 DOI: 10.14740/jmc4191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 04/23/2024] Open
Abstract
Gradenigo's syndrome (GS) is a rare entity characterized by otitis media, pain in the trigeminal nerve distribution and abducens nerve palsy. The classic triad is uncommon, making the diagnostic workup challenging. Specifically, the diagnostic approach includes medical history, a complete otorhinolaryngological examination, a pure-tone audiogram and radiological investigation such as contrast-enhanced computed tomography scan and magnetic resonance imaging of head and neck. Broad-spectrum antibiotics are the first-line treatment, such as intravenous (IV) ceftriaxone and IV metronidazole. Here, we present the case of a 71-year-old man with a previous history of otitis media and poorly controlled type 2 diabetes mellitus. He presented to our attention with facial pain, left hemilarynx paralysis, dysphagia and otorrhea. The patient was treated with broad-spectrum antibiotics without any clinical improvement. Imaging evaluations demonstrated the presence of wide and poorly defined pathological material with epicenter in the masticatory space, involving all nearby structures. The patient underwent multiple biopsies without obtaining a definitive tissue diagnosis of neoplasia. After 2 months, the patient developed delayed VI cranial nerve palsy, providing evidence of GS. Although incomplete, GS has been described in the literature; however, none of the cases exhibited a latent abducent deficit. To the best of our knowledge, this is the only case with a delayed onset of abducens nerve palsy.
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Affiliation(s)
- Fulvio Mammarella
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Antonella Loperfido
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Gianluca Velletrani
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Casorati
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Alessandro Stasolla
- Department of Neuroradiology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Stefano Di Girolamo
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Gianluca Bellocchi
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, 00152 Rome, Italy
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Chan KC, Chen SL. Diplopia in a Child: Gradenigo Syndrome Is an Unforgettable Disease. EAR, NOSE & THROAT JOURNAL 2023; 102:NP53-NP55. [PMID: 33507110 DOI: 10.1177/0145561321989459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Gradenigo syndrome is a clinical triad of abducens nerve palsy, retro-orbital pain (trigeminal ganglionitis), and chronic otorrhea (otitis media). The etiology of Gradenigo syndrome results from apical petrositis secondary to suppurative otitis media. Although apical petrositis has gradually become uncommon in modern society due to the widespread use of antibiotics, Gradenigo syndrome should be considered in the differential diagnosis of a child's diplopia.
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Affiliation(s)
- Kai-Chieh Chan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Lung Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
INTRODUCTION Petrous apicitis (PA) is a rare but dangerous complication of acute otitis media. The objective of this study is to present a case of PA and systematically review the existing literature on PA to characterize clinical presentation, diagnosis, management, and outcomes in the antibiotic era. METHODS A comprehensive search from 1983 to June 1, 2020, of PubMed, MEDLINE, Cochrane Library, and EmBase databases was conducted. Studies with clinical data regarding patients with PA were included. Non-English literature or studies with insufficient individual patient data were excluded. Sixty-seven studies were included with a total of 134 patients. RESULTS A total of 67 articles were found to meet criteria for inclusion. The mean age of presentation was 33 years. Recent acute otitis media was reported in 78 patients (58.2%). Only 3 patients (2.2%) were immunocompromised, and 8 patients (6.0%) had a history of diabetes. Gradenigo's triad of abducens palsy, otorrhea, and retro-orbital or facial pain was reported in 28 patients (20.9%); however, these presenting symptoms were common individually (51.5%, 48.5%, and 64.2%, respectively). Hearing loss (35.8%), facial weakness (17.9%), and vertigo (7.5%) were also reported.The most frequently cultured pathogen was Pseudomonas (34.2%), followed by Streptococcus and Staphylococcus. All 134 patients underwent imaging, with computed tomography being the most frequently used modality (56.0%). Nearly all patients received antibiotic therapy (95.6%), with 91 (67.9%) undergoing surgery ranging from myringotomy (26.9%) to petrosectomy (25.4%). Five patients (5.7%) died because of complications related to PA. Mean follow-up was 11.0 months. CONCLUSIONS Petrous apicitis has a variable presentation with potential for severe morbidity. Mortality rates are low, and presentation with Gradenigo's triad is uncommon. Appropriate medical management with surgical drainage can avoid long-term sequelae.
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Liu Y, Yeh PK, Lin YP, Sung YF. Steroid-Responsive Gradenigo's Syndrome Mimicking Subdural Hematoma. Cureus 2021; 13:e19547. [PMID: 34917431 PMCID: PMC8668413 DOI: 10.7759/cureus.19547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 01/18/2023] Open
Abstract
Gradenigo's syndrome (GS) is featured by a clinical triad of otorrhea, retro-orbital pain, and a sixth nerve palsy. Clinical examination is crucial prior to considering neuroimaging. The majority of cases are secondary to infection thus requiring long-term broad-spectrum antibiotics; severe cases also require surgical intervention for risk of intracranial abscess or even death. The patient was a 35-year-old female who presented with right temporal headache and right retro-orbital pain. The initial diagnosis from the local clinic was of subdural hemorrhage. Cranial nerve (CN) VI paresis was noted upon examination and inflammatory process was documented based on brain MR. The patient was diagnosed with Gradenigo's syndrome and administered antibiotics and steroids. Symptoms recurred after cessation of steroids and once antibiotics-related fever developed. The symptoms resolved after stopping the antibiotics and reintroducing steroids. The MRI performed after three months recorded no brain inflammation. We report a Gradenigo's syndrome caused by chronic inflammation with good response to steroids. To our best knowledge, there were merely approximately 80 patients who were reported with Gradnigo or Gradenigo's syndrome before. Infection comprised 76% of cases, thus broad-spectrum and long-term antibiotics use have been emphasized instead of steroid use. However, steroids also play an important role in reducing nerve injury by edematous change.
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Affiliation(s)
- Yi Liu
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, TWN
| | - Po-Kuan Yeh
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, TWN
| | - Yu-Pang Lin
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, TWN
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, TWN
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Valle Alonso J, Olivier M, Noblia L. [Gradenigo syndrome in an elderly patient with cholesteatoma]. Rev Esp Geriatr Gerontol 2020; 56:57-59. [PMID: 33303260 DOI: 10.1016/j.regg.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/05/2020] [Accepted: 09/18/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Joaquín Valle Alonso
- Servicio de Urgencias, Royal Bournemouth and Christchurch Hospital, Bournemouth, Reino Unido.
| | - Mike Olivier
- Servicio de Urgencias, Royal Bournemouth and Christchurch Hospital, Bournemouth, Reino Unido
| | - Leandro Noblia
- Servicio de Urgencias, Hospital Santa Lucía Cartagena, Murcia, España
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Li KL, Agarwal V, Moskowitz HS, Abuzeid WM. Surgical approaches to the petrous apex. World J Otorhinolaryngol Head Neck Surg 2020; 6:106-114. [PMID: 32596655 PMCID: PMC7296478 DOI: 10.1016/j.wjorl.2019.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Agarwal
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Howard S Moskowitz
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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Savasta S, Canzi P, Aprile F, Michev A, Foiadelli T, Manfrin M, Benazzo M. Gradenigo's syndrome with abscess of the petrous apex in pediatric patients: what is the best treatment? Childs Nerv Syst 2019; 35:2265-2272. [PMID: 31432224 DOI: 10.1007/s00381-019-04352-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Gradenigo's syndrome is defined by the classic clinical triad of ear discharge, trigeminal pain, and abducens nerve palsy. It has become a very rare nosological entity after the introduction of antibiotics, so that has been defined as the "forgotten syndrome." However, the underlying pathological process (apical petrositis) still represents a life-threatening condition that shall be immediately recognized in order to address the patient to the proper therapy. The therapy itself may be an argument of discussion: on a historical background ruled by surgery, reports of successful conservative antibiotic treatment have risen in recent years. METHODS AND RESULTS We reported a case of Gradenigo's syndrome in a child with an abscess of the left petrous apex and initial involvement of the carotid artery. After multidisciplinary evaluation, we decided to encourage conservative treatment, until complete regression was observed. DISCUSSION The available literature of the last 10 years was reviewed, with particular attention to the presence of an apical abscess and the therapeutic approach. The principles of management with regard to conservative therapy versus surgical indications are therefore examined and discussed.
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Affiliation(s)
- Salvatore Savasta
- Pediatric Clinic, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy.
| | - Pietro Canzi
- Department of Otorhinolaryngology, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Federico Aprile
- Department of Otorhinolaryngology, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Alexandre Michev
- Pediatric Clinic, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Marco Manfrin
- Department of Otorhinolaryngology, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
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Mancini AJ, Glassman RD, Chang YM, Burstein R, Ashina S. Headache in Petrous Apicitis: A Case Report of Chronic Migraine-like Headache Due to Peripheral Pathology. Headache 2019; 59:1821-1826. [PMID: 31535370 DOI: 10.1111/head.13643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. BACKGROUND Petrous apicitis is a rare complication of acute otitis media with varied clinical presentations that stem from the close proximity of the petrous apex to numerous neurovascular structures. Headache is among the common symptoms of petrous apicitis. METHODS A case of new onset headache in the setting of petrous apicitis with symptomatic response to antibiotic therapy was reported. We provided a brief review of peripheral pathophysiological mechanisms of migraine and correlated to mechanism of headache in petrous apicitis. RESULTS A 65-year-old man with chronic otitis externa/media presented with ongoing headache fulfilling International Classification of Headache Disorders 3rd edition (ICHD-3) criteria for chronic migraine without aura that persisted despite undergoing right mastoidectomy and tympanoplasty with multiple courses of oral antibiotic therapy for his chronic otitis. MRI brain revealed petrous apicitis, otomastoiditis, and clival osteomyelitis. His imaging findings improved and his migraine-like headache completely resolved after treatment with a prolonged course of antibiotics. CONCLUSIONS Petrous apicitis can present as a headache with features of migraine, and in this case in particular, as chronic migraine without aura. The pathophysiological mechanisms that may underlie the generation of migraine-like headache in petrous apicitis may include the activation of nociceptive fibers within the periosteum of the petrous apex and clivus whose cell bodies originate in the trigeminal ganglion and upper cervical dorsal root ganglia. By treating the peripheral pathology, resolution of the headache may be achieved.
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Affiliation(s)
- Alyssa J Mancini
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rebecca D Glassman
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yu-Ming Chang
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,BIDMC Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,BIDMC Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Hiyama T, Sekiya K, Kuno H, Oda S, Kusumoto M, Minami M, Kobayashi T. Imaging of extracranial head and neck lesions in cancer patients: a symptom-based approach. Jpn J Radiol 2019; 37:354-370. [PMID: 30911985 DOI: 10.1007/s11604-019-00832-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/17/2019] [Indexed: 02/06/2023]
Abstract
Besides intracranial lesions, neurological symptoms are also caused in cancer patients by extracranial lesions in the head and neck. Common symptoms caused by such lesions include visual loss, visual field defect, diplopia, ptosis, sensory abnormalities of the head and neck region, facial nerve palsy, dysphagia, dysarthria, hoarseness, and syncope. Some cancer patients often have multiple cranial nerve involvement, which is associated with several syndromes such as jugular foramen syndrome. The main causes of cranial nerve dysfunction due to extracranial lesions include bone and nodal metastasis, perineural tumor spread, inflammation, and radiation injury. The location of the lesions causing the neurological symptom may be estimated by the symptoms and physical examination. However, CT/MRI is critical for reaching the final diagnosis and for treatment planning and management of the cancer patients. Moreover, early identification of the extracranial lesions may significantly affect patient care and alter outcomes. Thus, radiologists should be familiar with imaging findings of the common neurological disorders and the complex anatomy of the head and neck region, which should be checked in cancer patients with neurological symptoms.
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Affiliation(s)
- Takashi Hiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Kotaro Sekiya
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shioto Oda
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.,Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Taklalsingh N, Falcone F, Velayudhan V. Gradenigo's Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1039-1043. [PMID: 28955030 PMCID: PMC5629926 DOI: 10.12659/ajcr.904648] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Male, 58 Final Diagnosis: Bacterial meningitis Symptoms: Altered mental status • headache • neck stiffness • vomiting Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Nicholas Taklalsingh
- Department of Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Franco Falcone
- Department of Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Vinodkumar Velayudhan
- Department of Radiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
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Jensen PVF, Avnstorp MB, Dzongodza T, Chidziva C, von Buchwald C. A fatal case of Gradenigo's syndrome in Zimbabwe and the Danish-Zimbabwean ENT collaboration. Int J Pediatr Otorhinolaryngol 2017; 97:181-184. [PMID: 28483232 DOI: 10.1016/j.ijporl.2017.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
As a part of a bilateral educational exchange program two Danish ENT residents were invited to Zimbabwe in 2015. During this exchange a 9-year-old girl was admitted due to complications to acute otitis media (AOM). She developed Gradenigo's syndrome and later on a brain abscess leading to a fatal outcome. Life threatening complications to AOM are rare in developed countries today but are still a challenge in developing countries. We put forward this case from a developing country to bring focus to the fact that a fatal outcome is the consequence if specialist treatment is not accessible.
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Affiliation(s)
- P V F Jensen
- Dept. of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - M B Avnstorp
- Dept. of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - T Dzongodza
- Dept. of Otorhinolaryngology, Parirenyatwa Hospital, Mazove Street, Harare, Zimbabwe
| | - C Chidziva
- Dept. of Otorhinolaryngology, Parirenyatwa Hospital, Mazove Street, Harare, Zimbabwe
| | - C von Buchwald
- Dept. of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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Jensen PVF, Hansen MS, Møller MN, Saunte JP. The Forgotten Syndrome? Four Cases of Gradenigo’s Syndrome and a Review of the Literature. Strabismus 2016; 24:21-7. [DOI: 10.3109/09273972.2015.1130067] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Plodpai Y, Hirunpat S, Kiddee W. Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report. J Med Case Rep 2014; 8:217. [PMID: 24957520 PMCID: PMC4086707 DOI: 10.1186/1752-1947-8-217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Gradenigo's syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. We present a case highlighting the pathological mechanism of this disease, demonstrate rare radiological findings associated with this patient, and showcase successful medical treatment without surgical intervention. CASE PRESENTATION A 63-year-old Thai man presented with complete Gradenigo triad as a complication of chronic otomastoiditis in spite of clinical history of previous radical mastoidectomy and a nonpneumatization of the petrous apex. Magnetic resonance imaging showed abnormal prominent enhancement at the roof of his right temporal bone, and the dura overlying the floor of right middle cranial fossa and right cavernous sinus. Magnetic resonance imaging also detected right petrous apicitis. With the use of intravenous antibiotics and topical antibiotic eardrops, recovery was observed within 5 days with complete resolution within 2 months. CONCLUSIONS Although there is little evidence to support the use of medical therapy in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome following chronic otitis media in a patient who underwent previous radical mastoidectomy.
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Affiliation(s)
- Yuvatiya Plodpai
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
| | - Siriporn Hirunpat
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
| | - Weerawat Kiddee
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
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Lee AG, Al-Zubidi N, Beaver HA, Brazis PW. An Update on Eye Pain for the Neurologist. Neurol Clin 2014; 32:489-505. [DOI: 10.1016/j.ncl.2013.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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