Oculomotor Nerve Spasm in Gradenigo's Syndrome

Abstract

In 1904 Gradenigo 1 described a triad of symptoms which has since been called Gradenigo's syndrome. It consists of acute otitis media, associated with pains in the head and paralysis of the sixth, or abducens, nerve, both of which occur on the same side as the aural condition. The pathologic condition of the ear may take the form of acute purulent otitis media or an exacerbation of chronic otitis without signs of mastoiditis, or the syndrome may occur during convalescence from an operation on the mastoid. The pains in the head, due to pressure on the gasserian ganglion, are as a rule severe, and may be occipital, temporoparietal, in or around the eye or referred to the teeth. As a result of the involvement of the sixth nerve (which, like that of the fifth nerve, is the effect of pressure exerted on the nerve by localized serous meningitis at the apex of the petrous pyramid), the patient complains of diplopia, and a paralytic internal strabismus develops. Numerous reports of cases in recent years have served to disprove the idea formerly held that the condition is extremely rare. Although the otologic problems of the syndrome have received adequate consideration, the ophthalmologic picture has not been fully presented in the literature.It is interesting to review briefly the r\l=o^\lethat is played by the various oculocranial nerves in the Gradenigo syndrome. The sensory part of the fifth nerve and the sixth nerve, as already noted, are regularly involved. The other nerves (the second, third, fourth and seventh) are not affected as a rule except when further complications of the condition in the ear arise, such as sinus thrombosis, abscess of the brain or diffuse suppurative meningitis. Occasionally, however, a disturbance of any one of these nerves may appear, even though clinically there is no evidence of intracranical complication.It is important, therefore, in the proper management of the case that the relative significance of such an event be fully appreciated. The finding of a choked disk, for instance, in the routine examination of the eye of a patient with Gradenigo's syndrome should not be regarded per se as an indication for surgical intervention, unless there is other well defined evidence of intradural involvement. This point was well Presented in part at a