Abstract
Aim Gradenigo’s syndrome is a characteristic triad of suppurative otitis media, pain in distribution of trigeminal nerve and abducens nerve palsy that is caused by contiguous spread of petrous apicitis secondary to otitis media. It is rare disorder, with incidence of 2 per 100,000.
Material and Method We reviewed the case of a 14-year-old boy who presented with severe mastoiditis and developed symptoms consistent with Gradenigo’s syndrome.
Results A 14-year-old boy presented with a three-day history of blood-streaked, profuse discharge from the right ear, mastoid bone tenderness, and restricted neck mobility. Initial neurological assessments were unremarkable. Several hours following admission, additional symptoms including swelling and painful movement of the right eye; as well as right 6th and 7th nerve palsies developed. Urgent CT Head and Neck showed severe otitis media and mastoiditis with thrombosis of right transverse sinus, internal jugular vein and cavernous sinus. MRI brain as shown in figure 1 and MRV Cerebral veins revealed an extensive epidural abscess at the skull base with intracranial extra axial extension, extensive cerebral sinus thrombosis and narrowing of internal carotid arteries. A multidisciplinary strategy resulted in his transfer to CHI Crumlin’s ENT department, where he underwent a right-sided cortical mastoidectomy. The predominant growth on culture was a streptococcus milleri. Post-surgery, the Infectious Disease and Microbiology teams consulted and recommended IV ceftriaxone and oral metronidazole for six weeks. A three-month course of rivaroxaban was prescribed on advice of Haematology. Follow-up at three months demonstrated considerable improvement, with no residual cranial nerve anomalies. Nonetheless, he experiences recurring, intermittent hearing loss on the right side and is receiving audiological input. Presently, he awaits additional imaging to evaluate the status of the thrombi.
MRI Brain.
Conclusions Gradenigo’s syndrome is a rare and life threatening complication of acute otitis media that requires prompt identification, with multidisciplinary intervention and care.
