Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature

Gradenigo Syndrome: A Case Report of a Rare Complication of Otitis Media

“…In our case, imaging studies played a pivotal role in confirming the diagnosis. Computed tomography revealed fluid accumulation within the middle ear and mastoid air cells, while magnetic resonance imaging with contrast highlighted peripheral enhancement around the fluid collection and dural enhancement around Meckel's cave [2][3][4]. These findings are consistent with the existing literature, emphasizing the utility of imaging in guiding diagnosis and facilitating timely intervention.…”

“…The case of our 38-year-old female patient sheds light on the clinical intricacies and challenges associated with this syndrome, emphasizing the importance of timely recognition and intervention. The rarity of Gradenigo's syndrome, coupled with its potential for serious complications, underscores the significance of heightened clinical awareness among healthcare professionals [1][2][3].…”

“…The syndrome's pathogenesis involves the extension of infection from the middle ear to the petrous apex of the temporal bone, leading to inflammation and involvement of the adjacent structures. Notably, the proximity of the petrous apex to critical neurovascular structures, such as the abducens nerve and Meckel's cave, contributes to the distinctive clinical features, including facial pain, otalgia, and abducens nerve palsy [ 3 , 4 ].…”

Atypical Gradenigo Syndrome in an Elderly Man Resolved with Mastoidectomy and Petrous Apicectomy

“…CT scans effectively detect bone erosions and air cell opacification [7] . MRI can provide further details including the aetiology of the lesion if not established, nerve involvement, possible underlying osteomyelitis, neoplastic lesions, and meningeal involvement [6,7] . However, the CT scan did not show involvement of the apex of the petrous bone in our case, and an MRI was needed to confirm the involvement of trigeminal, facial, vestibulocochlear and abducens nerves.…”

“…Although GS became rarer in the post-antibiotic era, this syndrome can still occur and cause serious complications, including cranial nerve palsies, intracranial abscess, meningitis, venous sinus thrombosis, subdural empyema and death [3] . Multiple cases of GS affecting adults have been reported in the last two decades as a rare complication of chronic otitis media [1,[4][5][6] . A systematic review performed by Gore [1] reported that the average age of GS patients was 22.4 years, while Gadre et al [4] (age ≥65 years).…”