Unrecognized Petrous Apicitis as a Cause of Long- Lasting Headache in a 5-Year-Old Child: Case Report

Malić, Mislav; Milicic, B.; Gjuric, Mislav

doi:10.5152/iao.2021.8553

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…Photophobia and recurrent episodes of acquired esotropia with concurrent OM are reported in pediatric population [16,18]. In children, the only PA symptom can be a long-lasting headache [19]. A recent classification proposal has divided the diagnostic categories of GS into three groups: classic presentation with evidence of PA, abducens nerve palsy, OM and trigeminal nerve pain; incomplete presentation with evidence of PA, abducens nerve palsy and OM or trigeminal nerve pain; mimic presentation without evidence of PA and abducens nerve palsy and OM or trigeminal nerve pain [20].…”

Section: Discussionmentioning

confidence: 99%

Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo’s Syndrome: Early Dysphagia and Late Abducens Nerve Palsy

Mammarella,

Loperfido,

Velletrani

et al. 2024

J Med Cases

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Gradenigo's syndrome (GS) is a rare entity characterized by otitis media, pain in the trigeminal nerve distribution and abducens nerve palsy. The classic triad is uncommon, making the diagnostic workup challenging. Specifically, the diagnostic approach includes medical history, a complete otorhinolaryngological examination, a pure-tone audiogram and radiological investigation such as contrast-enhanced computed tomography scan and magnetic resonance imaging of head and neck. Broad-spectrum antibiotics are the first-line treatment, such as intravenous (IV) ceftriaxone and IV metronidazole. Here, we present the case of a 71-year-old man with a previous history of otitis media and poorly controlled type 2 diabetes mellitus. He presented to our attention with facial pain, left hemilarynx paralysis, dysphagia and otorrhea. The patient was treated with broad-spectrum antibiotics without any clinical improvement. Imaging evaluations demonstrated the presence of wide and poorly defined pathological material with epicenter in the masticatory space, involving all nearby structures. The patient underwent multiple biopsies without obtaining a definitive tissue diagnosis of neoplasia. After 2 months, the patient developed delayed VI cranial nerve palsy, providing evidence of GS. Although incomplete, GS has been described in the literature; however, none of the cases exhibited a latent abducent deficit. To the best of our knowledge, this is the only case with a delayed onset of abducens nerve palsy.

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