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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clival osteomyelitis is a life-threatening complication of untreated malignant otitis externa or paranasal sinus infection. Although various pathogens have been implicated, to our knowledge, primary nocardial clival osteomyelitis has never been reported. We describe a 74-year-old woman who presented with headaches, abducens and hypoglossal nerve palsies, facial numbness, photophobia, and neck stiffness. Imaging revealed a heterogeneous mass within the sphenoid sinus with clival extension. The lesion was extirpated via a binostril endoscopic endonasal transsphenoidal approach. Histopathological and microbiological examination revealed a nocardial source. Clival osteomyelitis associated with sphenoid sinusitis should be included in the differential diagnosis of progressive skull base lesions in the setting of an underlying infection. Early recognition and intervention with antibiotics and surgical debridement is essential in the management of this rare entity.
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PMID:Nocardial clival osteomyelitis secondary to sphenoid sinusitis: an atypical skull base infection. 3060 37

Malignant otitis externa (MOE) is an aggressive but benign entity which evolves into skull base osteomyelitis. An 81-year-old female patient was admitted for left hemiparesis and homonymous hemianopia. She complained of headache radiating to the right cervical area. A recent history of recurrent otitis media was present. Head and neck imaging showed an ischemic infarction (right temporo-occipital) and a parapharyngeal soft tissue mass originating in an external and medial ear infection. Culture samples revealed Pseudomonas aeruginosa infection leading to the diagnosis of Malignant otitis externa (MOE). Parenteral antibacterial therapy and hyperbaric oxygen therapy resulted in improvement.
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PMID:Malignant Otitis Externa and Stroke. 3075 71

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew Candida albicans She was subsequently treated with long-term antifungals and antibiotics, and eventually recovered with good effect. The diagnostic dilemma and the empirical treatment of such a rare case are discussed.
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PMID:Rare case of a 3-year-old with Candida skull base osteomyelitis: lessons to be learnt. 3096 48

Potts puffy tumour (PPT) is a subperiosteal abscess arising from frontal bone osteomyelitis. We present a case of a 75-year-old lady with headache and a forehead swelling who was initially treated for sinusitis and giant cell arteritis in a primary care setting, but failed to improve. Following clinical deterioration and further investigation, CT appearances were consistent with a diagnosis of PPT and an extra-axial collection. Needle decompression, frontal trephine and endoscopic frontal sinusotomy were performed and intraoperative swabs cultured Streptococcus constellatus PPT is an unusual clinical entity that benefits from prompt antibiotic and surgical management, and therefore early recognition is paramount. We highlight that PPT should be a differential diagnosis in all patients presenting with forehead or frontal swelling. Use of radiological imaging (CT/MRI) is necessary to not only confirm a diagnosis of PPT but to identify further intracranial complications, which can be life-threatening.
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PMID:Potts puffy tumour: a rare but important diagnosis. 3096 34

Primary Calvarial Tuberculosis, a rare entity of skull is even rarer after second decade of life in a healthy person without evidence of tuberculosis elsewhere in the body. Most of the cases are often misdiagnosed as osteomyelitis/syphilis/bony metastasis. We report a case of primary skull tuberculosis in 26-year-old male with complains of headache and swelling in the right frontal region with no history of previous tuberculosis. The patient was operated and the histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after anti-tubercular therapy. Being a rare disease, tubercular osteomyelitis of skull bones is often missed and misdiagnosed due to lack of clinical suspicion and slow growth of mycobacterium cultures. Histopathological examination of biopsy material and demonstration of acid-fast bacilli in the pus are helpful for diagnosis and early management of the disease. Keywords: calvaria; Mycobacterium; osteomyelitis; tuberculosis.
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PMID:Calvarial Tuberculosis: A Diagnostic Quandary: A Case Report. 3147 63

We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.
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PMID:Insidious onset of headache, diplopia and Horner's syndrome: a rare case of petrous bone osteomyelitis. 3153 96

Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae. The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia.
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PMID:Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis. 3154

Background: Malignant otitis externa or skull base osteomyelitis arises as a complication of otological infection in immunocompromised individuals, especially elderly diabetics. With increasing awareness of the disease and better diagnostic modalities, there has been an increased reporting of atypical osteomyelitis of skull base (AOSB). Atypical osteomyelitis of skull base is a relatively rare yet an emerging clinical entity that also occurs in immunocompromised elderly individuals, however, in the absence of a pre-existing otological or rhinological infection. The purpose of this study was to review the clinical presentation and treatment protocol followed in patients diagnosed with atypical skull base osteomyelitis.Methods: A retrospective audit of medical records of patients diagnosed with AOSB between 2014 and 2018 was done. Clinical presentation and radiological assessment done prior to intervention was noted. All patients underwent transnasal endoscopic biopsy of tissue from clivus. Histopathological and microbiological profiling of biopsied tissue and treatment protocol followed was noted.Results: A total of 10 patients were included in the study out of which eight were male and two female. Eight patients were known diabetics and one patient had been on chronic oral steroid use. Majority presented with a vague dull aching headache and with one or more cranial nerve (CN) palsy(s). Radiological imaging showed clival involvement for all. All were managed conservatively with appropriate antibiotics. Disease resolution was defined as either complete resolution of symptoms and/or no residual lesion noted on follow-up MRI of skull base.Conclusions: Individuals presenting with non-specific symptoms of headache with CN palsy(s) with no obvious otological/rhinological infections, should raise suspicion of atypical skull base osteomyelitis. Histopathological diagnosis and microbiological assessment are an essential aid in conservative management with higher antibiotics. Patient compliance and long-term follow-up is essential for adequate and complete resolution of disease.
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PMID:Clinical profiling and management outcome of atypical skull base osteomyelitis. 3181 43

Central skull base osteomyelitis (CSBO) that has expanded to the middle cranial fossa is a rare complication of nasopharyngeal infection in children. Diagnosing CSBO is challenging in children, because specific symptoms are lacking and imaging findings can mimic skull base malignancy. We report on a 3-year-old girl who complained of pyrexia, headache, and vomiting and in whom a mass around the clivus was detected with magnetic resonance imaging. The patient received a diagnosis of CSBO based on characteristic imaging findings and the detection of a Streptococcus milleri group (SMG) in blood cultures. Clinical symptoms and abnormal imaging findings, including a mass lesion, were improved by prompt antibiotic treatment. The present patient had paranasal sinusitis with bacteremia of SMG, leading to the speculation of hematogeneous dissemination of SMG from the paranasal sinus. Awareness of CSBO, its early diagnosis, and aggressive management are required because CSBO is associated with high morbidity due to a life-threating infection involving multiple cranial nerves.
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PMID:A pediatric case of central skull base osteomyelitis caused by Streptococcus milleri group infection and mimicking malignancy. 3182 66

Cat scratch disease is known to be a generally benign, self-resolving illness associated with non-specific symptoms, including lymphadenopathy, fever, fatigue, anorexia, and headaches. However, it can also cause disseminated disease with a wide range of manifestations, including liver and spleen microabscesses, osteomyelitis, encephalitis, and uveitis. Eighteen pediatric cases of disseminated cat scratch disease at a single center in Hawai'i are described. This case series emphasizes the importance of disease recognition and use of appropriate diagnostic tools and disease management. The disease burden of pediatric patients with disseminated cat scratch disease in the state of Hawai'i has a high incidence and should be considered in pediatric patients with prolonged febrile illnesses.
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PMID:Disseminated Cat Scratch Disease in Pediatric Patients in Hawai'i. 3249 Mar 88


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