Acute otitis media associated with Gradenigo syndrome and transverse sinus thrombosis: a case report

Abstract

Gradenigo syndrome is associated with middle ear infection that extends to the petrous apex, leading to pain at the innervation site of the ophthalmic and maxillary branches of the trigeminal nerve and the development of abducens nerve palsy. Cerebral venous sinus thrombosis is a serious neurological complication of otitis media and occurs secondary to spread of the infection to the underlying bone. We herein report a pediatric case of otitis media associated with Gradenigo syndrome and ipsilateral sigmoid–transverse sinus thrombosis with magnetic resonance imaging findings.

Gradenigo’s Syndrome with Carotid Septic Stenosis

“…MRI is more sensitive in detecting dural thickening and enhancement as well as intracranial complications and has the advantage of avoiding unnecessary radiation to the patient. A MRI angiography may be performed to rule out signs of sinus thrombosis [4,13].…”

“…To the best of our knowledge, very few case reports have been published describing venous sinus thrombosis in GS, and only two reported the commitment of the carotid artery [4][5][6][7][8][9][10].…”

Delayed diagnosed Gradenigo’s syndrome associated with acute otitis media

“…However, most studies have reported antibiotic therapy as the acceptable first-line treatment for Gradenigo’s syndrome. 2 , 4 , 5 , 8 The petrous apex is a hard-to-reach area surgically. Considering both the difficulties and complications associated with surgery, it seems more feasible to avoid complicated surgery as the first-line treatment.…”

“…Retroorbital pain is a result of the involvement of the trigeminal nerve, and horizontal diplopia may occur with involvement of the abducens nerve, which innervates the lateral rectus muscle. 5 Both CT and MRI play crucial role in the diagnosis of petrous apicitis. 4 CT can help to determine the bone structure, while MRI can identify the cranial involvement.…”

Neurological complications of acute otitis media in children

“…Анализ причин развития осложненных форм острого среднего отита показывает, что их процент не снижается, а в лечении осложнений хирургическая тактика остается ведущей [6,7].Наиболее тяжелые осложнения острых гнойных отитов -поражения нервной системы. Они включают как поражения ЦНС (менингиты, менингоэнцефалиты, абсцессы головного мозга, тромбозы синусов) [8], так и патологию черепных нервов [9]. В лор-отделении Детской республиканской клинической больницы Минздрава Республики Татарстан (ДРКБ МЗ РТ) за период с 2009 по 2018 г. проведено 182 антромастоидотомии.…”