Gradenigo's syndrome with lateral venous sinus thrombosis: successful conservative treatment

Abstract

Gradenigo's syndrome (GS) is a rare disease characterised by the triad otitis media, pain in the region innervated by the first and the second division of trigeminal nerve and abducens nerve palsy. Septic sinus thrombosis is one of the most frequent and relevant complication of GS; it is often due to persistent damage and late diagnosis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allow the correct diagnosis in most cases. Surgical therapy may be necessary for a better and more rapid resolution of the disease. We report the case of a 4-year-old child that was admitted for facial nerve palsy and abducens nerve palsy subsequent to a 2-week persistent pain in the right ear. MRI showed infective acute process of the right mastoid and partial ipsilateral sinus thrombophlebitis. The child was treated with high-dose intravenous antibiotics and with oral anticoagulants. A complete resolution of symptoms and radiological alterations were observed within 7 weeks. In conclusion, lateral sinus thrombosis and Gradenigo's syndrome are rare but potential fatal complications of otitis media and mastoiditis. High-dose intravenous antibiotics and a low dose of anticoagulant can achieve a complete recovery without surgery.

Gradenigo’s syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report

“…The time interval between the onset of otitis media and the clinical presentation of abducens nerve palsy varies from 1 week to 2 to 3 months [4]. Most reported cases of GS in the last decade developed secondary to acute otitis media in children [1,2,4-7]. The present case is an unusual presentation of GS associated with previous history of radical mastoidectomy.…”

“…Most cases of petrous apicitis do not present with the classic clinical triad, however [2,3]. The time interval between the onset of otitis media and the clinical presentation of abducens nerve palsy varies from 1 week to 2 to 3 months [4]. Most reported cases of GS in the last decade developed secondary to acute otitis media in children [1,2,4-7].…”

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

“…Gradenigo syndrome is an uncommon complication of middle ear infection characterized by otitis media, pain in the innervation region of the ophthalmic and maxillary branches of the trigeminal nerve, and ipsilateral abducens nerve palsy. 1,2 The spread of inflammation from the middle ear to the petrous apex, which is close to Dorello’s canal and Meckel’s cave, affects the abducens nerve and the ophthalmic and maxillary branches of the trigeminal nerve. This leads to pain in the retro-orbital region, which is innervated by these branches of the trigeminal nerve, and to palsy of the rectus lateralis muscle, which is innervated by the abducens nerve.…”

“…Cerebral sinus venous thrombosis is an important complication of otitis media that usually spreads via underlying bone tissue. 1…”

Gradenigo’s Syndrome with Carotid Septic Stenosis

“…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].…”