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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1907, Gradenigo described the syndrome of constant otorrhea, headache, and diplopia which he attributed to inflammation of the petrous apex. In 1908, Baldenweck described the pathology of petrositis. Renewed interest in this syndrome occurred 20 years later through the papers of Eagleton, Kopetsky and Almour, Frenckner, and Ramadier. Various surgical approaches were described during the 1930's by Eagleton, Frenckner, Ramadier, and on this continent by Lempert. In 1932, Lillie and Williams reported two cases of petrositis from the Mayo Clinic. Stacey Guild in 1935 and John Lindsay in 1938 reported on the pathology of petrositis in post mortem cases. After the advance of chemotherapy, Thornell and Williams in 1946, emphasized the need for adequate surgical drainage. In 1958 DeWeese reported three cases of petrositis with the admonition "Lest we forget that this condition still occurs". The purpose of this paper is to present a case of petrositis and to stress the importance of modern radiological techniques in its diagnosis and management.
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PMID:Gradenigo's syndrome revisited. 687 44

Sphenoid sinusitis is an elusive diagnosis with significant morbidity if not diagnosed and treated promptly. We have reported an unusual case of acute sphenoiditis mimicking Gradenigo's syndrome. This resulted in virtual bilateral blindness that entirely resolved with aggressive surgical and medical treatment. It is recommended that sphenoid sinusitis be strongly considered in patients with acute headache and fever. A detailed cranial nerve examination should be performed, and CT scans of the skull base and paranasal sinuses should be obtained. Immediate surgery is strongly recommended for acute sphenoid sinusitis at the first suggestion of a complication and in those patients not promptly responding to medical therapy. It is apparent that irreversible damage to the optic nerve can occur before the development of gross intraorbital pathology. Therefore we believe that delaying surgery until the visual acuity is worse than 20/60, as advocated by some authors, may not be in the patient's best interest. Surgery should be directed at removing the purulent material, obtaining cultures, removing irreversibly diseased mucosa, and maintaining drainage of the sphenoid sinus.
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PMID:Reversible blindness secondary to acute sphenoid sinusitis. 777 62

We report about a boy with the symptoms of Gradenigo's syndrome (abducens nerve palsy, acute otitis media, unilateral headache). The MR imaging showed a sinus vein thrombosis instead of the expected petroapicitis. After 2 weeks of conservative therapy with antibiotics and anticoagulation, without any clinical effort the boy underwent a mastoidectomy. Headache and otitis media recovered quickly but the diplopia still remained after 25 months.
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PMID:Prolonged diplopia following sinus vein thrombosis mimicking Gradenigo's syndrome. 1628 Jan 72

The syndrome of constant otorrhea, headache, and diplopia, which is attributed to inflammation of the petrous apex, is known as Gradenigo's syndrome. It is often the result of chronic otitis media with long-standing purulent otorrhea. It has traditionally been treated surgically, but recent advances in imaging, allied with improved antibiotic treatment, have allowed for consideration of non-surgical management of these cases. A 60-year-old woman presented to the emergency department with 7 days of right-sided headache, facial pain, and diplopia. She awoke with the headache and facial pain 7 days earlier. She was without any preceding infectious symptoms including ear pain, sinus congestion, sore throat, and cough, and she denied fevers and chills. Examination demonstrated a right eye lateral gaze palsy and reproducible diplopia. Computed tomography studies demonstrated the possibility of fluid in the petrous apex of the temporal bone. A follow-up magnetic resonance imaging study confirmed a moderate amount of fluid in the right petrous apex consistent with Gradenigo's syndrome. Imaging with computed tomography and magnetic resonance is an important tool in the evaluation of petrous apex lesions. Gradenigo's syndrome is a rare condition that does not always present with the classical triad of otorrhea, headache, and diplopia. Appropriate management requires antibiotic treatment and possible surgical intervention.
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PMID:Gradenigo's syndrome. 1829 9

Acute otitis media is the most common bacterial infection in children. Despite efficient antibiotic therapy, there are still reports of both intratemporal and intracranial complications with potential risk of high morbidity and mortality. Mastoiditis, apical petrositis and labyrinthitis are caused by the extension of purulent middle ear infection into nearby structures. Giuseppe Gradenigo first described the clinical triad of acute otitis media, unilateral pain in the region innervated by the 1 masculine and 2 masculine branches of the trigeminal nerve and ipsilateral abducens nerve paralysis. This is a serious but rare complication of middle ear infection that should be suspected in every patient with unilateral headache and abducens nerve palsy. We report a case of Gradenigo's syndrome in a 6-year-old boy.
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PMID:[Gradenigo's syndrome: a case-report]. 2054 25

Tolosa-Hunt syndrome is an idiopathic chronic granulomatous inflammatory process commonly involving the cavernous sinus and the orbit. Symptoms include unilateral eye pain, ophthalmoplegia, headache, and facial pain in the distribution of the upper divisions of the trigeminal nerve and are highly responsive to steroid therapy. Gradenigo syndrome describes extension of a middle ear infection to the petrous apex, with trigeminal pain and ophthalmoplegia, typically responsive to antibiotics and often surgical drainage. We report a case of a 17 year-old girl with apparent Gradenigo syndrome, presenting with unilateral eye pain, abducens palsy, headache, hearing loss and serous otitis media, who was ultimately diagnosed with Tolosa-Hunt syndrome.
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PMID:Tolosa-Hunt syndrome masquerading as Gradenigo syndrome in a teenager. 2368 66

Gradenigo syndrome is caused by petrous inflammation, also called petrositis. It includes acute otitis media, diplopia, and homolateral retroorbital pain due to trigeminal and abducens nerve injury. We describe a child with petrositis secondary to acute otitis media. The lack of otoscopic abnormality and the presence of bilateral headache made the diagnostic difficult. After complementary investigations searching for an intracranial process, the diagnosis was made based on brain and skull base dimensional computed tomography.
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PMID:[Gradenigo syndrome and petrositis in a child]. 2552 89

BACKGROUND 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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PMID:Gradenigo's Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis. 2895 30

Gradenigo's syndrome (GS) classically involves a triad of ear pain due to acute or chronic otitis media (OM), facial or retro-orbital pain in the distribution of the trigeminal nerve, and an abducens nerve palsy. The simultaneous presentation of all three components has become less common in cases of GS reported in the literature, particularly in the era of antibiotics effective against typical organisms attributed to OM and petrous apicitis. In addition to infectious petrous apicitis arising directly from OM, more recent cases of GS are attributed to the compression of the same traversing cranial nerves in the presence of various expansile petrous apex (PA) lesions, both benign and malignant. We report a case of a 24-year-old male who presented initially with nausea, fever, photophobia, left-sided retro-orbital pain, and headache. He was diagnosed with bacterial meningitis by lumbar puncture and treated with empiric antibiotics, with CSF eventually revealing nontypeable Haemophilus influenzae. Several days into his course, he developed diplopia with leftward gaze. Brain imaging revealed an expansile, erosive PA cholesterol granuloma with associated contiguous dural and leptomeningeal enhancement. The patient improved with antibiotics and eventually underwent surgical intervention. This atypical presentation of GS with a rare complication of meningitis in the setting of a PA granuloma demonstrates the importance of early recognition of this syndrome, as well as consideration of added surgical intervention in patients with pre-existing petrous lesions at potentially higher risk of dangerous complications of GS.
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PMID:Gradenigo's Syndrome and Bacterial Meningitis in a Patient with a Petrous Apex Cholesterol Granuloma. 3313 7