ABSTRACT
We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.
Subject(s)
Horner Syndrome/diagnosis , Osteomyelitis/complications , Petrous Bone/microbiology , Skull Base/microbiology , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/etiology , Administration, Intravenous , Aged, 80 and over , Carbapenems/administration & dosage , Carbapenems/therapeutic use , Diplopia/diagnosis , Diplopia/etiology , Female , Headache/diagnosis , Headache/etiology , Humans , Magnetic Resonance Imaging/methods , Osteomyelitis/drug therapy , Petrous Bone/diagnostic imaging , Petrous Bone/pathology , Skull Base/diagnostic imaging , Skull Base/pathology , Treatment OutcomeSubject(s)
Abducens Nerve , Cranial Nerve Diseases/diagnosis , Otitis/complications , Otitis/diagnosis , Petrous Bone , Trigeminal Nerve , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Child , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/etiology , Female , Fosfomycin/therapeutic use , Humans , Magnetic Resonance Imaging , Otitis/drug therapy , Petrous Bone/microbiology , Tomography, X-Ray ComputedABSTRACT
Aspergillus infection of the petrous apex is a rare and devastating condition. To date, only two such cases have been reported, which resulted from direct extension of chronic Aspergillus otitis media. We present a case of petrous apex aspergillosis occurring years after surgical drainage of a petrous apex granuloma cyst. Because of the potential lethal nature of this condition, aggressive surgical therapy should be considered early in this illness and may provide the best chance for survival.
Subject(s)
Aspergillus fumigatus/isolation & purification , Cholesterol , Granuloma, Foreign-Body/complications , Neuroaspergillosis/etiology , Petrous Bone/microbiology , Amphotericin B/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Basilar Artery/microbiology , Cerebrospinal Fluid Rhinorrhea/drug therapy , Cerebrospinal Fluid Rhinorrhea/etiology , Fatal Outcome , Fluconazole/therapeutic use , Granuloma, Foreign-Body/surgery , Headache/etiology , Humans , Magnetic Resonance Imaging , Male , Methicillin Resistance , Middle Aged , Neuroaspergillosis/drug therapy , Neuroaspergillosis/pathology , Ofloxacin/therapeutic use , Otorhinolaryngologic Surgical Procedures , Petrous Bone/pathology , Sphenoid Sinus/surgery , Subarachnoid Space/microbiologySubject(s)
Bacterial Infections/complications , Bacterial Infections/microbiology , Cavernous Sinus Thrombosis/etiology , Petrous Bone/microbiology , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Bacterial Infections/drug therapy , Cavernous Sinus Thrombosis/pathology , Child , Drug Therapy, Combination , Female , Humans , Magnetic Resonance Imaging , Prednisolone/therapeutic useABSTRACT
An 83-year-old man with a lifelong history of intermittent otorrhea and hearing loss was referred for management of a facial paralysis of 3 weeks' duration. Computed tomography (CT) of the head detected a neoplasm of the nasopharynx along with chronic otomastoiditis. A followup CT suggested the development of a nasopharyngeal abscess, which was confirmed by needle aspiration. A later coronal-projection CT showed definite bone destruction in the anterior petrous apex, confirming suspicions that a petrous apicitis was responsible for the facial paralysis and abscess. This article describes the management of this patient and reviews the historical, medical, and surgical aspects of petrous apicitis.
Subject(s)
Abscess/etiology , Bone Diseases/complications , Bone Diseases/microbiology , Facial Paralysis/etiology , Nasopharyngeal Diseases/etiology , Petrous Bone/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Abscess/diagnosis , Aged , Aged, 80 and over , Bone Diseases/diagnosis , Facial Paralysis/diagnosis , Humans , Male , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Neoplasms/complications , Nasopharyngeal Neoplasms/pathology , Petrous Bone/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Blastomyces/isolation & purification , Blastomycosis/diagnosis , Blastomycosis/microbiology , Petrous Bone , Petrous Bone/microbiology , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Blastomycosis/complications , Blastomycosis/drug therapy , Diagnosis, Differential , Facial Paralysis/diagnosis , Facial Paralysis/etiology , Hearing Loss, Conductive/diagnosis , Hearing Loss, Conductive/etiology , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/etiology , Humans , Itraconazole/administration & dosage , Itraconazole/therapeutic use , Magnetic Resonance Imaging , Male , Middle Aged , Petrous Bone/diagnostic imaging , Petrous Bone/pathology , Tomography, X-Ray ComputedABSTRACT
Our objective was to discuss the management and outcome of abducens nerve palsy in patients with Gradenigo's syndrome. In a retrospective analysis of patients with Gradenigo's syndrome at a tertiary-care center in Houston, Texas, from 1987 to 1995, we identified 2 patients with Gradenigo's syndrome, both female. One had bilateral involvement, so that the total was 3 ears. Both patients had complete recovery of their abducens nerve palsy. In 2 ears with chronic mastoiditis, sixth nerve palsies failed to respond to medical therapy alone, but resolved after mastoidectomy with drainage of the petrous apex. We recommend that patients with Gradenigo's syndrome and evidence of chronic mastoiditis be treated with aggressive medical and surgical care.
