Gradenigo's Syndrome Research Articles

Abducens nerve palsy in a young girl with otorrhea: A case of Gradenigo's syndrome

Abducens nerve palsy in a young girl with otorrhea: A case of Gradenigo's syndrome

Gradenigo Syndrome With Facial and Hypoglossal Nerve Impairment Caused by Nontuberculous Mycobacteria Successfully Treated by Antibiotics Without Surgery.

Gradenigo Syndrome With Facial and Hypoglossal Nerve Impairment Caused by Nontuberculous Mycobacteria Successfully Treated by Antibiotics Without Surgery.

Клинический случай синдрома Градениго, сложности дифференциальной диагностики

Gradenigo syndrome develops with pathology of the apex of the temporal bone pyramid. This syndrome is characterized by a clinical lesion of the vestibulocochlear nerve in combination with dysfunction of the abducens, trigeminal and facial nerves. The rarity of occurrence of the syndrome, the lack of experience of doctors working with patient with this pathology, the small namber of publications in Russian scientific journals on the diagnosis and treatment of diseases in the area of the apex of the temporal bone lead to the lack of timely diagnosis and adequate treatment of diseases that cause syndrome. The article describes a clinical case of a patient with Gradenigo syndrome, which developed as a result of pathology of the apex of the temporal bone and associated with a neoplasm, which was subsequently determined to be a poorly differentiated carcinoma with squamous cell differentiation of the skull base.

A rare Case of Rhabdomyosarcoma presenting as Gradenigo syndrome in a child

Objective: To study a rare case of Rhabdomyosarcoma. Methods: Observational descriptive study of a case, a 3-year-old female child, presenting to our OPD. She was thoroughly examined and radiological investigations (HRCT Temporal bone and MRI Brain) were done. The Neurosurgery department proceeded with a biopsy of the lesion by left temporal bone craniotomy through subtemporal approach. Results: Histopathology suggested a Rhabdomyosarcoma of anaplastic type. The patient then underwent 6 cycles of Chemoradiation. Conclusion: The awareness that Rhabdomyosarcoma of petrous apex can present as Gradenigo syndrome along with 7th nerve palsy is important for the early diagnosis and its treatment.

Gradenigo's syndrome – A Diagnostic Challenge

We report a case of a 5-year-old healthy child that presented to the emergency department with a 4-day history of prostration, headache, cervical pain, and fever. She had a history of acute otitis media 8 weeks before. She presented a hyperaemic and bulged left tympanic membrane as well as limitation of left eye abduction. Blood tests showed increased inflammatory markers. She performed a cerebral, cervical and ear region computed tomography showing the left mastoid region, left ear, and left petrous apex filled with secretions in relation with mastoiditis and petrositis. A lumbar punction was performed and treatment with ceftriaxone 100mg/kg/day was initiated. After exclusion on meningitis, the antibiotic was changed cefuroxime 150mg/Kg/day. She was submitted to a left myringotomy with tympanostomy tube placement and, after, she presented a rapid improvement of cervical pain and headache with no more documented fever. During hospitalization, she performed a magnetic resonance imaging that show signs of mastoiditis and petrositis. There was no evidence of cerebral extension of inflammatory process and all the venous sinus presented preserved flow. At discharge, she was clinically asymptomatic with normalization of inflammatory parameters. At physical examination she still presented limitation of left eye abduction. She completed a total of 6 weeks of antibiotic treatment. Due to persistent VI cranial nerve palsy one month after discharge, an injection of botulinum toxin was performed, with complete resolution.

Complication of acute Otitis media in pediatrics: a case report

The acute otitis media (AOM) is a frequent bacterial infection in Pediatrics. Despite the advance of antibiotic therapy in the treatment of this infection, there is the possibility of a rare complication, Gradenigo Syndrome (GS). This is a serious complication that should be suspected in a patient with abducens nerve paralysis, pain in the trigeminal innervation area and AOM. The objective of this work was to describe a case report in pediatric regarding to Gradenigo’s Syndrome and reinforce the importance of early diagnosis in the treatment. In addition, a literature review of articles in journals indexed in the following databases was carried out: Pubmed, Lilacs and Scielo. The case report presented is a 7-year-old girl, presenting a typical clinical of GS that evolved satisfactorily with the management based on broad-spectrum antibiotic therapy, without the need for a subsequent surgical approach. Thus, it is clear that the identification of the classic triad of GS, in addition to performing imaging tests, allows for an early diagnosis of the disease, favoring a conservative approach with antibiotic therapy.

Abstract 13090: Not Your Simple Swimmer’s Ear: Ramsay Hunt Syndrome Complicated by Gradenigo Syndrome, Varicella Zoster Meningoencephalitis, and Superimposed Bacterial Necrotizing Otitis Externa in a Heart Transplant Patient on Chronic Immunosuppression

Introduction: Orthotopic heart transplantation (OHT) increases the risks of varicella-zoster reactivation, and severe complications may arise due to infection in the setting of active immunosuppression. Complications include meningitis, facial nerve palsy (known as Ramsay Hunt Syndrome), and bacterial superinfection. When severe bacterial ear infections spread to the petrous apex, facial pain accompanied by otitis media and abducens nerve palsy may also occur, classically known as Gradenigo Syndrome. Case Report: We present a case of a patient 15 months post OHT who came in with left-sided facial droop and pain, abducens palsy, crusting facial rash, and ear swelling. Imaging revealed necrotizing otitis externa, with associated otitis media, petrous apicitis, and signs suggestive of encephalitis. A viral panel resulted positive for zoster infection, with superimposed methicillin-resistant staphylococcus aureus infection. Despite treatment with antibiotics and antivirals, the patient's mentation declined, with subsequent lumbar puncture revealing zoster meningoencephalitis. The patient’s mycophenolate mofetil (MMF) immunosuppression was suspended, and he was continued solely on therapeutic tacrolimus. His antiviral was switched to intravenous acyclovir and he was continued on six weeks of antibiotic therapy. The patient demonstrated resolution of his acute infection, however he continues to have residual facial and abducens nerve palsies. On discharge, the patient was resumed on MMF without any cardiac complications. Conclusions: This is the first documented case of Ramsay Hunt Syndrome, complicated by Gradenigo Syndrome and varicella-zoster virus meningoencephalitis in an OHT recipient. Our patient's immunosuppression level was the most important factor leading to the concurrence of these novel complications. Physicians should consider and assess for symptoms of these potential sequelae in all transplant patients, and carefully manage immunosuppressive agents to allow for resolution of the infection, while avoiding rejection. While residual neurologic deficits may be challenging to manage, this case demonstrated successful treatment of these complications while avoiding significant cardiac sequelae.

Gradenigo Syndrome: Retro-orbital Pain, Abducens Palsy, and Petrous Apicitis

Gradenigo's syndrome is a rarely encountered triad of otitis media, retro-orbital pain, and abducens nerve palsy. Originally described in the early 1900s by Giuseppe Gradenigo, it is the physical manifestation of a lesion involving the petrous apex of the temporal bone, oftentimes in the setting of a pneumatized petrous apex/temporal bone; a noted normal anatomical variant that may predispose to infection. Local irritation of the ipsilateral trigeminal and abducens nerves leads to retro-orbital pain and abducens palsy, respectively.

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

Gradenigo syndrome (GS) was described primarily in the paediatric population, especially in the pre-antibiotic era. GS is rarely reported in the elderly population, especially in the post-antibiotic era. We present the rare case of a 67-year-old man who presented with an incomplete triad of symptoms (without abducens nerve palsy) of GS that failed medical therapy and was successfully treated with surgical intervention (mastoidectomy and petrous apicectomy). Physicians should be familiar with atypical presenting symptoms of GS as it can lead to life-threatening complications, especially in the elderly. GS cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention.LEARNING POINTSGradenigo syndrome may present with an incomplete triad (without abducens nerve palsy), especially in the post-antibiotic era.Gradenigo syndrome can rarely affect immunocompromised elderly patients.Gradenigo syndrome cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention (mastoidectomy and petrous apicectomy).

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

Gradenigo syndrome (GS) was described primarily in the paediatric population, especially in the pre-antibiotic era. GS is rarely reported in the elderly population, especially in the post-antibiotic era. We present the rare case of a 67-year-old man who presented with an incomplete triad of symptoms (without abducens nerve palsy) of GS that failed medical therapy and was successfully treated with surgical intervention (mastoidectomy and petrous apicectomy). Physicians should be familiar with atypical presenting symptoms of GS as it can lead to life-threatening complications, especially in the elderly. GS cases resistant to medical therapy may require prompt appropriate imaging studies and surgical intervention.

A Case of Gradenigo Syndrome that Occurred in the Third Trimester of Pregnancy and Was Successfully Treated Conservatively

A Case of Gradenigo Syndrome that Occurred in the Third Trimester of Pregnancy and Was Successfully Treated Conservatively

Incomplete Gradenigo Syndrome in a Patient With Mastoiditis and Lateral Sinus Thrombosis.

Incomplete Gradenigo Syndrome in a Patient With Mastoiditis and Lateral Sinus Thrombosis.

Gradenigo Syndrome: Mimicker of Slipped Muscle and Shunt Failure.

Seeds, Anais BS; Coleman, Sydni L. MD; Strul, Sasha MDEditor(s): Avery, Robert DO; Golnik, Karl C. MD; Froment, Caroline MD, PhD; Wang, An-Gour MD Author Information

Gradenigo syndrome and acute disseminated encephalomyelitis: An infective and inflammatory combo

A 14 year old male presented with complaints of giddiness for two days.He had a history of left sided ear pain and a purulent discharge from the left ear one month ago. He had signs of cerebellar ataxia.On examining his left ear three point tenderness and tragal tenderness was present. On Day 4 he developed diplopia, facial pain and a GCS of 15/15. On examination he revealed a left lateral rectus palsy. CT Brain showed no evidence of raised intracranial tension. MRI Brain showed evidence of encephalitis. A cerbrospinal fluid analysis was within normal limits. The patient was suspected with Acute Disseminated Encephalomyelitis (ADEM) following otitis media of the left ear with an active episode of mastoiditis causing Gradenigo syndrome. Patient was treated with intravenous antibiotics, steroids and his condition improved.: Acute meningoencephalitis and Acute Disseminated Encephalomyelitis need to differentiated at the earliest to facilitate a faster recovery and aslo to minimize the neurological deficits. Combination of an infectious and inflammatory pathology can pose a serious problem.

Facial Neuritis as a Manifestation of Gradenigo's Syndrome

AbstractGradenigo's syndrome (GS) is a rare, acquired syndrome caused by middle ear infections or mastoiditis. It is identified by the triad of otorrhea due to otitis media (OM), retro-orbital pain in the region innervated by the first and second divisions of the trigeminal nerve, and diplopia as a result of cranial nerve (CN) VI palsy. As a result of extension of the inflammation, the facial nerve (VII) may also be affected. GS has a poor prognosis unless promptly diagnosed and treated. Herein, we report the clinical and radiological findings observed in two children diagnosed with chronic suppurative OM, mastoiditis, and facial neuritis. Both were medically managed as cases of GS with high-dose intravenous antibiotic and full recovery was achieved a few weeks after discharge. There was no need for any surgical intervention. This case report illustrates the importance of early recognition, diagnosis, and treatment of this treatable syndrome using antibiotics to prevent subsequent fatal complications and further need for surgical intervention.

Intracranial Mass Lesion Caused by Inflammatory Pseudotumor: A Case Report and Discussion

Inflammatory pseudo tumors are uncommon lesions that may, on occasion, occupy the intracranial space. Their management is unstandardized. We present a case of skull-based inflammatory pseudotumor in a 14-year-old boy who presented with multiple cranial nerve palsies mimicking Gradenigo syndrome. This illustrative case and a review of the literature is presented to highlight noteworthy features of this rare condition. These include that inflammatory pseudotumor may be multifocal and biopsy of a more accessible, smaller lesion may prove diagnostic.

Diplopia in a Child: Gradenigo Syndrome Is an Unforgettable Disease.

Gradenigo syndrome is a clinical triad of abducens nerve palsy, retro-orbital pain (trigeminal ganglionitis), and chronic otorrhea (otitis media). The etiology of Gradenigo syndrome results from apical petrositis secondary to suppurative otitis media. Although apical petrositis has gradually become uncommon in modern society due to the widespread use of antibiotics, Gradenigo syndrome should be considered in the differential diagnosis of a child's diplopia.

Petrous apicitis complicated by meningitis with intracranial air presenting as incomplete Gradenigo syndrome

Petrous apicitis complicated by meningitis with intracranial air presenting as incomplete Gradenigo syndrome

Streptococcus Acidominimus’in Sebep Olduğu Subakut Enfektif Endokarditli Çocuk Olgu

Streptococcus acidominimus is rarely pathogenic in humans and is usually detected in veterinary science. In the literature, there are approximately 20 case reports that Streptococcus acidominimus is a human pathogen. They are pneumonia, pericarditis, infective endocarditis, sepsis, brain abscess and gradienigo syndrome. Only two of these cases were in the pediatric age group, one was infective endocarditis at the age of 15 years, other one was otitis media and gradenigo syndrome at the age of 12 years. There are no cases of invasive infection due to Streptococcus acidominimus in Turkey. Here, we report a case of infective endocarditis caused by Streptococcus acidominimus at 14 years of age.

Streptococcus acidominimus’in Sebep Olduğu Subakut Enfektif Endokarditli Çocuk Olgu

Streptococcus acidominimus is rarely pathogenic in humans and is usually detected in veterinary science. In the literature, there are approximately 20 case reports that Streptococcus acidominimus is a human pathogen. They are pneumonia, pericarditis, infective endocarditis, sepsis, brain abscess and gradienigo syndrome. Only two of these cases were in the pediatric age group, one was infective endocarditis at the age of 15 years, other one was otitis media and gradenigo syndrome at the age of 12 years. There are no cases of invasive infection due to Streptococcus acidominimus in Turkey. Here, we report a case of infective endocarditis caused by Streptococcus acidominimus at 14 years of age.