A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

Abstract

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

Atypical skull base osteomyelitis in the intensive care unit: A case report

“…There is a potential risk of carotid artery thrombosis as well. [7] In our case, there was partial thrombosis of the left jugular vein, left sigmoid sinus and lateral third of the transverse sinus (see Figure 4). Infection and inflammation associated with osteomyelitis may lead to an inflammatory arteritis, with formation of plaques prone to rupture.…”

“…MRI with gadolinium contrast may be effective in evaluating the exact area of skull base osteomyelitis, although it could not be used in the present case due to renal failure. [7] In conclusion, in this case of osteomyelitis of base of skull, the inflammation also involved multiple cranial nerves resulting in bulbar weakness. Imaging findings may represent a red herring and require to be substantiated by a prompt tissue biopsy and culture to arrive at a diagnosis.…”

“…Infection and inflammation associated with osteomyelitis may lead to an inflammatory arteritis, with formation of plaques prone to rupture. [7] The total duration of antibiotic therapy for skull base osteomyelitis remains undefined at present, although 6 weeks of intravenous antibiotics for the treatment of native vertebral osteomyelitis, as suggested by the Infectious Diseases Society of America, may be taken as a guideline. [8] The Bone Infection Unit in Oxford, United Kingdom, recommends both intravenous antibiotics up to 6 weeks followed by oral medications for 6 to 12 months, depending on clinical improvement.…”

Rare case of a 3-year-old withCandidaskull base osteomyelitis: lessons to be learnt

“…The general treatment consists of long-term antimicrobial treatment with surgical intervention reserved for poorly responding patients or those with neurological involvement. There is no clear consensus on the length of antimicrobial treatment6; however, in the literature, a common regime is approximately 6 weeks of intravenous antibiotics followed by a variable course of oral antibiotics or antifungals for up to 6–12 months 3 5 6 10. In our patient, after the change to oral antibiotics, she endured repeated admissions with infection.…”

Fungal Osteomyelitis of Temporomandibular Joint and Skull Base Caused by Chronic Otitis Media

“…It presents in different forms: otogenic and non-otogenic [6,11]. Most otogenic SBO is mainly caused by P. aeruginosa [7,12]. P. aeruginosa infection causes headaches, ear pain, facial pain, swelling around the orbital area.…”