Gradenigo’s Syndrome: Beyond the Classical Triad of Diplopia, Facial Pain and Otorrhea

Pedroso, José Luiz; Aquino, Camila C.; Abrahão, Agessandro; Oliveira, Ricardo Araújo de; Pinto, Lauro Figueira; Bezerra, Márcio Luis Escórcio; Silva, Antonio Beuttenmuller Gonçalves; Macedo, Francisca Delanie Bulcão de; Mendes, Ana Valéria de Melo; Barsottini, Orlando Graziani Póvoas

doi:10.1159/000324179

Cited by 22 publications

(24 citation statements)

References 6 publications

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“…Patients were 22.4 years of age on average with an equal gender distribution. The main etiology was described as bacterial otitis media with apex involvement of the petrous part of the temporal bone causing localized osteomyelitis and reactive meningitis [3] . However, atypical causes, with lymphomas, petrous apex pachymeningitis, extradural abscess, cholesteatomas and chronic osteomyelitis have been described.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings

Quesada

Kong

Tweddle

2021

Radiology Case Reports

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With the widespread use of antibiotics, Gradenigo syndrome is a rare complication of acute otitis media (AOM) and acute mastoiditis. It is an uncommon form of petrous apicitis and can be life-threatening. We report the case of a 14-year-old female with unresolved AOM, who developed otorrhea, ipsilateral headaches, diplopia and raised inflammatory markers. Magnetic Resonance Imaging (MRI) demonstrated features of petrous apicitis and confirmed the suspicion of Gradenigo syndrome. The objective of this clinical case report is to highlight this unusual syndrome together with its radiological appearance to improve its diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings

Quesada

Kong

Tweddle

2021

Radiology Case Reports

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“…The dura above the tegmen tympani is enhanced and extends to the right cavernous sinus. MRI is also beneficial in delineating the differential diagnosis of the many causes of GS, such as osteomyelitis, abscesses, cholesteatomas, neoplasms, and inflammatory granulomas [ 10 , 11 ]. Ibrahim et al .…”

Section: Discussionmentioning

confidence: 99%

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

2014

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IntroductionGradenigo’s syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. We present a case highlighting the pathological mechanism of this disease, demonstrate rare radiological findings associated with this patient, and showcase successful medical treatment without surgical intervention.Case presentationA 63-year-old Thai man presented with complete Gradenigo triad as a complication of chronic otomastoiditis in spite of clinical history of previous radical mastoidectomy and a nonpneumatization of the petrous apex. Magnetic resonance imaging showed abnormal prominent enhancement at the roof of his right temporal bone, and the dura overlying the floor of right middle cranial fossa and right cavernous sinus. Magnetic resonance imaging also detected right petrous apicitis. With the use of intravenous antibiotics and topical antibiotic eardrops, recovery was observed within 5 days with complete resolution within 2 months.ConclusionsAlthough there is little evidence to support the use of medical therapy in the treatment of Gradenigo’s syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo’s syndrome following chronic otitis media in a patient who underwent previous radical mastoidectomy.

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“…Zudem können die Symptome Kopfschmerzen und Tinnitus bestehen. Diese Entität ist seit der breitflächigen Anwendung von Antibiotika selten geworden und wird leicht übersehen, wenn das klinische Bild unvollständig und atypisch ist [66,67].…”

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Akute Kopfschmerzen in der Notaufnahme

Guryildirim¹,

Kontzialis²,

Ozen³

et al. 2021

Neuroradiologie Scan

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Acute headache is a common symptom and is reported by approximately 2 % – 4 % of patients who present to the emergency department. Many abnormalities manifest with headache as the first symptom, and it is crucial to obtain a patient’s complete clinical history for correct diagnosis. Headache onset, duration, and severity; risk factors such as hypertension, immunosuppression, or malignancy; and the presence of focal neurologic deficits or systemic symptoms may aid the radiologist in deciding whether imaging is appropriate and which modality to choose. Imaging findings are more likely to be abnormal in patients with a “thunderclap” headache than in those with headaches of lesser severity. The causes of headache in the emergency setting are various. They may manifest at imaging as subarachnoid hemorrhage (ruptured aneurysm, reversible vasoconstriction syndrome, or pituitary apoplexy), parenchymal hemorrhage (hypertension, ruptured arteriovenous malformation, cerebral amyloid angiopathy, dural arteriovenous fistula, or sinus thrombosis), or parenchymal edema (posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, sinus thrombosis, or encephalitis). Alterations in intracranial pressure that are related to idiopathic intracranial hypertension or spontaneous intracranial hypotension and prior lumbar puncture or epidural injection may manifest with specific imaging findings. With accumulating knowledge of disease pathophysiology, radiologists have started to play a more central role in making the correct diagnosis. This article reviews multiple causes of acute headache and their characteristic appearances at multimodality imaging and familiarizes the reader with current concepts in imaging.

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Gradenigo’s Syndrome: Beyond the Classical Triad of Diplopia, Facial Pain and Otorrhea

Cited by 22 publications

References 6 publications

An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings

An unusual case of acute otitis media resulting in Gradenigo syndrome: CT and MRI findings

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

Akute Kopfschmerzen in der Notaufnahme

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