28 September 2017
: Case report
Gradenigo’s Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Nicholas Taklalsingh1ABCDEFG*, Franco Falcone1BCD, Vinodkumar Velayudhan2BCDDOI: 10.12659/AJCR.904648
Am J Case Rep 2017; 18:1039-1043
Abstract
BACKGROUND: Gradenigo’s syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve. Gradenigo’s syndrome is rare, and the diagnosis is easily overlooked. This case is the first to report Gradenigo’s syndrome presenting with meningitis on a background of chronic suppurative otitis media (CSOM) and petrous apicitis (apical petrositis).
CASE REPORT: A 58-year-old male African American presented with headaches and confusion. Magnetic resonance imaging (MRI) of the head showed petrous apicitis with mastoiditis and abscess formation in the cerebellomedullary cistern (cisterna magna). The case was complicated by the development of palsy of the fourth (trochlear) cranial nerve, fifth (trigeminal) cranial nerve, and sixth (abducens) cranial nerve, with radiological changes indicating infection involving the seventh (facial) cranial nerve, and eighth (vestibulocochlear) cranial nerve. Cerebrospinal fluid (CSF) culture results were positive for Klebsiella pneumoniae, sensitive to ceftriaxone. The patient improved with surgery that included a left mastoidectomy and debridement of the petrous apex, followed by a ten-week course of antibiotics. Follow-up MRI showed resolution of the infection.
CONCLUSIONS: This report is of an atypical case of Gradenigo’s syndrome. It is important to recognize that the classical triad of Gradenigo’s syndrome, suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve, may also involve chronic suppurative otitis media (CSOM), which may lead to involvement of other cranial nerves, petrous apicitis (apical petrositis), and bacterial meningitis.
Keywords: Klebsiella, Meningitis, Bacterial, Otitis Media, Petrositis
SARS-CoV-2/COVID-19
30 June 2022 : Editorial
Med Sci Monit In Press; DOI: 10.12659/MSM.937676
29 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
16 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936498
13 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936889
In Press
30 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.937061
30 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
30 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936967
29 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936313
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
09 Feb 2022 : Case report
DOI :10.12659/AJCR.934744
Am J Case Rep 2022; 23:e934744