Skull Base Osteomyelitis from Otitis Media Presenting as the Collet-Sicard Syndrome

Abstract

Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. The Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII. We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome. Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. This case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and ultimately the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums.

Central skull base osteomyelitis due to nasopharyngeal Klebsiella infection

“…Our patient also recovered after 8 weeks of intensive antibiotic treatment with ceftriaxone and vancomycin targeting the Klebsiella infection. Central SBO caused by Klebsiella has been reported in patients with sphenoid sinus cholesteatoma [12] and a history of previous ear infections [11,13]. Thus, to our knowledge, this is the first report of a central SBO case caused by nasopharyngeal Klebsiella infection.…”

Vernet’s syndrome (jugular foramen syndrome) secondary to osteoma of the tympanic bulla in a young male dog

“…Jugular foramen syndrome is considered a rare clinical presentation in human beings, with the most common underlying aetiology being paraganglionoma of the head and neck 12. While not an exhaustive list, other reported aetiologies have included jugular vein thrombosis,13 local metastatic lesions14 and skull base osteomyelitis secondary to chronic otitis media 15. In the osteomyelitis case reported by Low and Lhu,15 the disease extended to involve cranial nerve XII, producing a related condition, Collet‐Sicard syndrome.…”

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy: a report and review of literature

“…Due to the proximity of stylomastoid foramen to the nidus of inflammation, VII nerve palsy is the commonest as well as the earliest neurological deficit to be seen in MOE ( Karaman et al., 2012 ; Chen et al., 2010 ; Carfrae and Kesser, 2008 ; Spielmann et al., 2013 ). If the predisposing factors are not controlled or if the infective organism is highly virulent or is resistant to the antibiotic given, the inflammation may progress further inferio-medially to involve lower cranial nerves of the jugular foramen namely, IX, X, and XI, and at times could result in IJV thrombosis or even internal carotid artery thrombosis ( Ali et al., 2010 ; Das et al., 2019 ; Lee et al., 2008 ; Spielmann et al., 2013 ; Mani et al., 2007 ; Huang and Lu, 2006 ; Conde-Diaz et al., 2017 ; Low and Lhu, 2018 ). If conditions prevail, the skull base inflammation can rapidly extend further medially to involve cranial nerves V and VI at the petrous apex, anteriorly to include temporomandibular joint, zygomatic bone, and posteriorly or superiorly, can enter the intracranial compartment causing meningitis, cerebral infarction or sigmoid sinus thrombosis ( Das et al., 2019 ; Spielmann et al., 2013 ; Mani et al., 2007 ; Sikka et al., 2015 ).…”

“…The partial thrombosis of sigmoid sinuses seen on MRI is probably due to the retrograde progression of thrombus from IJV to sigmoid sinus, as a result of sluggish or hampered blood flow. The MOE is also known to cause jugular foramen syndrome with IJV thrombosis ( Low and Lhu, 2018 ; Kornilenko et al., 2017 ). However, jugular foremen was also an unlikely site of involvement in our case since the cranial nerves X and XI were normal clinically, and the jugular foremen was not involved radiologically.…”

“…The IJV thrombosis in MOE by itself has been reported sparsely and very rarely has this been attributed to parapharyngeal space involvement ( Kornilenko et al., 2017 ; Low and Lhu, 2018 ; Kornilenko et al., 2017 ; Davidoss et al., 2015 ; Turan et al., 2014 ). On the other hand, though many authors have reported a non-predictable spread of the MOE to involve non-contagious sites belonging to separate compartments causing VI, VII, IX, X, XI, XII nerve palsies in various combinations very rarely these deficits have been thought to be due to parapharyngeal space involvement.…”