Multidisciplinary care of a paediatric patient with Gradenigo's syndrome

Abstract

A 10-year-old girl presented with signs and symptoms suggestive of Gradenigo's syndrome, a condition characterised by otorrhoea, diplopia due to abducens nerve palsy and pain in the region of the trigeminal nerve. This case examines the presentation of this condition, and the appropriate investigations. We also highlight the importance of the involvement of multiple specialities in discussing and devising a suitable management plan.

Gradenigo’s Syndrome with Carotid Septic Stenosis

“…Indeed, surgical debridement is necessary in very severe cases or cases resistant to medical treatment alone [15]. Another case report by Janjua et al of a patient with GS with epidural abscess and internal carotid arteritis has described a good response to myringotomy and grommet insertion combined with antibiotic and antiplatelet therapy [10]. However, the authors considered mastoidectomy unnecessary given the partially opacified mastoid air cells in the CT, which was not our case.…”

“…Regarding the choice of antibiotics for treatment of GS, most authors advocate for the use of a cephalosporin antibiotic along with metronidazole with or without the addition of vancomycin [10,11]. Empirical intravenous antibiotics should cover common agents involved in bacterial mastoiditis (Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, and Pseudomonas aeruginosa) and anaerobic organisms can also be considered [16,17].…”

“…e patient was diagnosed with GS based on her clinical presentation, which included acute suppurative otitis media with involvement of the sixth cranial nerve, and based on the evidence of petrous apicitis (apical petrositis) on the CT. e imaging studies also revealed the presence of cavernous sinus thrombosis and carotid septic stenosis. Other differential diagnosis of petrous apicitis including congenital cholesteatoma, intracranial abscess, lateral sinus thrombosis, cholesterol granuloma, temporal bone osteomyelitis, and neoplastic or granulomatous disease were excluded according to the clinical and radiological presentation [10,11].…”

“…To the best of our knowledge, very few case reports have been published describing venous sinus thrombosis in GS, and only two reported the commitment of the carotid artery [4][5][6][7][8][9][10].…”

Gradenigo's syndrome in a four-year-old patient: a rare diagnosis in the modern antibiotic era

“…The pathophysiology of neuropraxia associated with Gradenigo's syndrome can be explained by inflammation of Dorello's canal and Meckel's cave combined with neural oedema compressing the abducens and trigeminal nerves. 10 The abducens nerve contacts the apex of the petrous part of the temporal bone as it runs under the petroclinoid ligament and through Dorello's canal. The trigeminal nerve and ganglion lie within the petrous apex.…”