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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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Schmit C, Runge A, Jöbstl A, Widmann G, Schmutzhard J, Hofauer B. [Sudden-onset double vision-a complication requiring interdisciplinary treatment]. HNO 2024:10.1007/s00106-024-01450-x. [PMID: 38498175 DOI: 10.1007/s00106-024-01450-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/20/2024]
Affiliation(s)
- C Schmit
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - A Runge
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - A Jöbstl
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - G Widmann
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - J Schmutzhard
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - B Hofauer
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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Ramos de Ascanio V, Liaño-Esteso G, Roldán D, Collazo-Lorduy T, Martínez-Flores S, Hernández-Rivas JÁ, González-Gascón-y-Marín I. Challenging Diagnosis of Invasive Sinus Aspergillosis Mimicking Gradenigo's Syndrome in an Elderly Patient with T-Cell Lymphoma. Geriatrics (Basel) 2023; 9:4. [PMID: 38247979 PMCID: PMC10801611 DOI: 10.3390/geriatrics9010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/02/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Gradenigo's Syndrome (GS) is a rare complication of acute otitis media characterized by the triad of diplopia, otitis, and facial pain. The widespread use of antibiotics has significantly reduced its occurrence. (2) Case summary: We present the case of an elderly patient with T-cell lymphoma who developed neurological deficits resembling GS. The patient was ultimately diagnosed with invasive sinus aspergillosis. The diagnostic process was challenging due to the atypical clinical presentation and the lack of specific imaging findings. A biopsy was the most important test for clarifying the diagnosis. (3) Conclusions: The prognosis for this complication is extremely poor without surgery, and the patient died despite adequate antifungal coverage. Therefore, maintaining high clinical suspicion is paramount to avoid adverse outcomes in similar cases, particularly in the geriatric population, wherein this syndrome's occurrence may not be expected.
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Affiliation(s)
| | | | - David Roldán
- Pathology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Teresa Collazo-Lorduy
- Otorhinolaryngology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Sara Martínez-Flores
- Geriatrics Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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Kloth C, Beck A, Sollmann N, Beer M, Horger M, Thaiss WM. Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review. Tomography 2023; 9:2190-2210. [PMID: 38133074 PMCID: PMC10747582 DOI: 10.3390/tomography9060170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Radiology and Radiation Therapy Lindau, Friedrichshafener Str. 83, 88131 Lindau (Lake Constance), Germany
| | - Annika Beck
- Institute of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Tournegros R, Tringali S, Fieux M. Persistent retro-orbital pain after acute otitis media. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:247-249. [PMID: 37024398 DOI: 10.1016/j.anorl.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- R Tournegros
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - S Tringali
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; UMR 5305, laboratoire de biologie tissulaire et d'ingénierie thérapeutique, institut de biologie et chimie des protéines, CNRS/université Claude-Bernard-Lyon 1, 7, passage du Vercors, 69367 Lyon cedex 07, France
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, Hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Inserm, IMRB, université Paris Est-Créteil, 94010 Créteil, France; CNRS EMR 7000, 94010 Créteil, France.
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Nassrallah WB, Noel de Tilly L, Micieli JA. Case of Petrous Apicitis After COVID-19 Infection. J Neuroophthalmol 2023; Publish Ahead of Print:00041327-990000000-00365. [PMID: 37256704 DOI: 10.1097/wno.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Wissam B Nassrallah
- Faculty of Medicine (WBN), University of British Columbia, Vancouver, Canada; Division of Neuroradiology (LNdT), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada
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Supsupin EP, Gonzales NS, Debnam JM. Anatomy and Pathology of the Skull Base: Malignant and Nonmalignant Lesions. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00025-0. [PMID: 37142448 DOI: 10.1016/j.coms.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The skull base (SB) is the osseous foundation of the cranial vault. It contains many openings that allow communication between the extracranial and intracranial structures. This communication is crucial in normal physiologic processes yet may also arrow spread of disease. This article provides a comprehensive review of SB anatomy including important landmarks and anatomic variants relevant to SB surgery. We also illustrate the diverse pathologies affecting the SB.
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Affiliation(s)
- Emilio P Supsupin
- Radiology/Neuroradiology, Radiology Residency Program, University of Florida College of Medicine, 655 West 8th. Street, Jacksonville, FL 32209, USA.
| | - Noelani S Gonzales
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL 33314, USA
| | - James Matthew Debnam
- Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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