The Forgotten Syndrome? Four Cases of Gradenigo’s Syndrome and a Review of the Literature

Jensen, Pernille Vita Fooken; Hansen, Michael Stormly; Möller, Martin; Saunte, Jon Peiter

doi:10.3109/09273972.2015.1130067

Cited by 28 publications

(27 citation statements)

References 19 publications

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“…e ideal treatment for petrous apicitis is controversial and typically depends on the severity of clinical presentation [14]. Recently, some authors have advocated for nonsurgical intervention with intravenous antibiotic therapy [15]. In our case, surgical treatment was decided, combined with antibiotic therapy due to the severity of clinical presentation with vascular commitment.…”

Section: Discussionmentioning

confidence: 89%

“…Previous reports have described variable intravenous antibiotic therapy between 10 and 64 days [12,15]. Undoubtedly, petrositis caused by infection is equivalent to osteomyelitis, which needs intensive and prolonged antibiotic treatment to avoid relapse [15]. In our case, we considered the 21 days of antibiotic therapy sufficient given the complete resolution of symptoms in the days after surgery.…”

Section: Discussionmentioning

confidence: 92%

“…In our case, surgical treatment was decided, combined with antibiotic therapy due to the severity of clinical presentation with vascular commitment. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Our case report stands out for its relatively short intravenous antibiotic therapy duration. Previous reports have described variable intravenous antibiotic therapy between 10 and 64 days [12,15]. Undoubtedly, petrositis caused by infection is equivalent to osteomyelitis, which needs intensive and prolonged antibiotic treatment to avoid relapse [15].…”

Section: Discussionmentioning

confidence: 99%

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Gradenigo’s Syndrome with Carotid Septic Stenosis

Menezes

Ribeiro

Balona

et al. 2020

Case Reports in Otolaryngology

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Gradenigo’s syndrome was firstly described in 1907 by Giusseppe Gradenigo and is defined as the clinical triad of suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the first and the second branches of the trigeminal nerve. Since the advent of antibiotics, the incidence of this potentially life-threatening complication has diminished, but occasional cases still occur. We herein report a pediatric case of otitis media associated with Gradenigo’s syndrome complicated by ipsilateral septic cavernous sinus thrombosis and infectious arteritis of the internal carotid artery.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gradenigo’s Syndrome with Carotid Septic Stenosis

Menezes

Ribeiro

Balona

et al. 2020

Case Reports in Otolaryngology

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“…Gradenigo’s syndrome has become very rare since the availability of antibiotics to treat bacterial otitis media, but cases have been recently documented with chronic suppurative otitis media (CSOM) and cholesteatoma [ 3 , 4 ]. Inflammation of the petrous part of temporal bone, petrous apicitis (apical petrositis), is usually present [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Gradenigo’s Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis

2017

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Patient: Male, 58Final Diagnosis: Bacterial meningitisSymptoms: Altered mental status • headache • neck stiffness • vomitingMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Gradenigo’s syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve. Gradenigo’s syndrome is rare, and the diagnosis is easily overlooked. This case is the first to report Gradenigo’s syndrome presenting with meningitis on a background of chronic suppurative otitis media (CSOM) and petrous apicitis (apical petrositis).Case Report:A 58-year-old male African American presented with headaches and confusion. Magnetic resonance imaging (MRI) of the head showed petrous apicitis with mastoiditis and abscess formation in the cerebellomedullary cistern (cisterna magna). The case was complicated by the development of palsy of the fourth (trochlear) cranial nerve, fifth (trigeminal) cranial nerve, and sixth (abducens) cranial nerve, with radiological changes indicating infection involving the seventh (facial) cranial nerve, and eighth (vestibulocochlear) cranial nerve. Cerebrospinal fluid (CSF) culture results were positive for Klebsiella pneumoniae, sensitive to ceftriaxone. The patient improved with surgery that included a left mastoidectomy and debridement of the petrous apex, followed by a ten-week course of antibiotics. Follow-up MRI showed resolution of the infection.Conclusions:This report is of an atypical case of Gradenigo’s syndrome. It is important to recognize that the classical triad of Gradenigo’s syndrome, suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve, may also involve chronic suppurative otitis media (CSOM), which may lead to involvement of other cranial nerves, petrous apicitis (apical petrositis), and bacterial meningitis.

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Bilateral papilledema and abducens nerve palsy following cerebral venous sinus thrombosis due to Gradenigo's syndrome in a pediatric patient

Costa

João

Guimarães

2020

American Journal of Ophthalmology Case Reports

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Purpose To report a case of bilateral papilledema and abducens nerve palsy following cerebral venous sinus thrombosis in a 9-year-old female with undiagnosed Gradenigo's Syndrome. Observations The patient presented to our Emergency Room with a unilateral left 6th nerve palsy, left eye relative afferent pupillary defect, and bilateral papilledema. She underwent cranial magnetic resonance imaging with gadolinium contrast and magnetic resonance venography, which diagnosed a left mastoiditis, left sigmoid sinus and jugular vein thrombosis. The patient underwent urgent mastoidectomy and myringotomy with tube placement and was admitted for adequate treatment with intravenous antibiotics and anticoagulants. Conclusions and importance Gradenigo's syndrome is a rare complication of otitis media, and even rarer is cerebral venous thrombosis. This potentially life-threatening situation requires immediate surgical and antibiotic therapy. Ocular symptoms can be the initial signs of this illness.

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The Forgotten Syndrome? Four Cases of Gradenigo’s Syndrome and a Review of the Literature

Abstract: GS is a rare and potentially life-threatening complication to otitis media. GS can present in an acute and chronic form, and should be a differential diagnosis in the workup of unexplained sixth nerve palsy.

Cited by 28 publications

References 19 publications

Gradenigo’s Syndrome with Carotid Septic Stenosis

Gradenigo’s Syndrome with Carotid Septic Stenosis

Gradenigo’s Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis

Bilateral papilledema and abducens nerve palsy following cerebral venous sinus thrombosis due to Gradenigo's syndrome in a pediatric patient

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