Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature
Gradenigo's syndrome (GS) is a triad (otorrhea, abducens nerve palsy, and pain in the trigeminal nerve distribution) of clinical findings that are caused by contiguous spread of petrous apicitis to the nearby neurovascular structures. Petrous apicitis is usually secondary to otitis media but at...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | eNeurologicalSci |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405650222000065 |
| _version_ | 1818555789398245376 |
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| author | Safia Bano Ahmad Nawaz Abyaz Asmar Muhammad Aemaz Ur Rehman Hareem Farooq Hamid Ali |
| author_facet | Safia Bano Ahmad Nawaz Abyaz Asmar Muhammad Aemaz Ur Rehman Hareem Farooq Hamid Ali |
| author_sort | Safia Bano |
| collection | DOAJ |
| description | Gradenigo's syndrome (GS) is a triad (otorrhea, abducens nerve palsy, and pain in the trigeminal nerve distribution) of clinical findings that are caused by contiguous spread of petrous apicitis to the nearby neurovascular structures. Petrous apicitis is usually secondary to otitis media but atypical etiologies and absence of the classical triad pose a diagnostic challenge for physicians. We report a rare case of GS in an afebrile 55-year-old male who presented with unilateral headache, dysphagia and hoarseness (IX and X cranial nerve involvement), and diplopia with lateral gaze palsy (VI nerve involvement) in the absence of trigeminal neuralgia or a history of otitis media. Magnetic Resonance Imaging (MRI) revealed hyperintense lesions in the right petrous apex indicating petrous apicitis, the hallmark of GS. Prompt initiation of broad-spectrum antibiotics led to a marked improvement in dysphagia and voice quality on the 4th post-admission day, and complete resolution of symptoms by the end of the fourth week. This shows that GS can present even in the absence of clinically apparent ear infection and cranial nerve palsies may not be limited to the V and VI nerve in all cases. Physicians should be aware of such atypical manifestations as prompt radiological assessment followed by early antibiotics can prevent life-threatening complications from developing. |
| first_indexed | 2024-12-12T09:58:10Z |
| format | Article |
| id | doaj.art-3d43fba57b5145478e635d0e89c13428 |
| institution | Directory Open Access Journal |
| issn | 2405-6502 |
| language | English |
| last_indexed | 2024-12-12T09:58:10Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | eNeurologicalSci |
| spelling | doaj.art-3d43fba57b5145478e635d0e89c134282022-12-22T00:28:03ZengElseviereNeurologicalSci2405-65022022-06-0127100397Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literatureSafia Bano0Ahmad Nawaz1Abyaz Asmar2Muhammad Aemaz Ur Rehman3Hareem Farooq4Hamid Ali5Department of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, PakistanDepartment of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, PakistanDepartment of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, Pakistan; Corresponding author.Department of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, PakistanDepartment of Neurology, Mayo Hospital, King Edward Medical University, Lahore 54000, PakistanDepartment of Neurology, Medical University of South Carolina, United StatesGradenigo's syndrome (GS) is a triad (otorrhea, abducens nerve palsy, and pain in the trigeminal nerve distribution) of clinical findings that are caused by contiguous spread of petrous apicitis to the nearby neurovascular structures. Petrous apicitis is usually secondary to otitis media but atypical etiologies and absence of the classical triad pose a diagnostic challenge for physicians. We report a rare case of GS in an afebrile 55-year-old male who presented with unilateral headache, dysphagia and hoarseness (IX and X cranial nerve involvement), and diplopia with lateral gaze palsy (VI nerve involvement) in the absence of trigeminal neuralgia or a history of otitis media. Magnetic Resonance Imaging (MRI) revealed hyperintense lesions in the right petrous apex indicating petrous apicitis, the hallmark of GS. Prompt initiation of broad-spectrum antibiotics led to a marked improvement in dysphagia and voice quality on the 4th post-admission day, and complete resolution of symptoms by the end of the fourth week. This shows that GS can present even in the absence of clinically apparent ear infection and cranial nerve palsies may not be limited to the V and VI nerve in all cases. Physicians should be aware of such atypical manifestations as prompt radiological assessment followed by early antibiotics can prevent life-threatening complications from developing.http://www.sciencedirect.com/science/article/pii/S2405650222000065Case reportCranial nerve palsiesGradinego's syndrome, otitis mediaOtorhinolaryngologic diseasesPetrositis |
| spellingShingle | Safia Bano Ahmad Nawaz Abyaz Asmar Muhammad Aemaz Ur Rehman Hareem Farooq Hamid Ali Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature eNeurologicalSci Case report Cranial nerve palsies Gradinego's syndrome, otitis media Otorhinolaryngologic diseases Petrositis |
| title | Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature |
| title_full | Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature |
| title_fullStr | Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature |
| title_full_unstemmed | Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature |
| title_short | Gradenigo's syndrome presenting as IX and X cranial nerve palsy without clinically apparent ear infection: A case report and review of literature |
| title_sort | gradenigo s syndrome presenting as ix and x cranial nerve palsy without clinically apparent ear infection a case report and review of literature |
| topic | Case report Cranial nerve palsies Gradinego's syndrome, otitis media Otorhinolaryngologic diseases Petrositis |
| url | http://www.sciencedirect.com/science/article/pii/S2405650222000065 |
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