Clinical communication: AdultsGradenigo's Syndrome
Introduction
The syndrome of constant otorrhea, headache, and diplopia, which is attributed to inflammation of the petrous apex, is known as Gradenigo's syndrome. These symptoms were initially attributed to inflammation of the petrous apex, also called petrous apicitis or petrositis. This condition is often the result of chronic otitis media with long-standing purulent otorrhea. We present this case to make emergency physicians aware of this entity, and to discuss diagnostic work-up and management options.
Section snippets
Case Report
A 60-year-old woman presented with 7 days of right-sided headache, facial pain, and diplopia. She noted the diplopia only upon looking to the right. She reported that the headache was behind the right eye and in the right temporal region. She stated that she awoke with the headache and facial pain 7 days earlier. The retro-orbital and facial pain had markedly worsened in the 2 days before presentation. She delayed going to the emergency department, thinking that the symptoms would resolve
Discussion
In 1907, Gradenigo described the syndrome of constant otorrhea, headache, and diplopia, which he attributed to inflammation of the petrous apex, also called petrous apicitis or petrositis (1). In 1908, Baldenweck described the pathology of petrositis (1). This patient presented with the acute form of a petrous apicitis that is often the result of an abscess in the poorly pneumatized petrous apex. The chronic form of petrous apicitis, as seen in the case report by Sherman and Buchanan, is often
Conclusions
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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Cited by (16)
Gradenigo syndrome in an elderly patient with cholesteatoma
2021, Revista Espanola de Geriatria y GerontologiaSurgical approaches to the petrous apex
2020, World Journal of Otorhinolaryngology - Head and Neck SurgeryGradenigo syndrome and primitive sphenoid sinus cancer
2017, Egyptian Journal of Ear, Nose, Throat and Allied SciencesCitation Excerpt :In our case, the sphenoid sinus tumor was revealed by a well-defined clinical entity: Gradenigo’s syndrome. This syndrome was first described by Gradenigo in 1907 as a triad associating constant otorrhea, headache and diplopia, which were attributed to inflammation of the petrous apex.4 In 1908, Baldenweck described the pathology of petrositis.4
A fatal case of Gradenigo's syndrome in Zimbabwe and the Danish-Zimbabwean ENT collaboration
2017, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :CT scans are preferred to describe bone destruction, which can be seen due to infection. Magnetic Resonance Imaging (MRI) is valuable in describing Central Nervous System (CNS) pathology and meningeal enhancement and holds information on the composition of the process, which cannot be obtained by a CT scan [13,15]. A CT scan is often the primary investigation when GS is suspected, as it is readily available with a low false-positive rate [13].
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2014, Neurologic ClinicsCitation Excerpt :Headache syndromes can present with eye findings or ocular symptoms. These are listed in Table 2.47–69 The practicing neurologist should be aware of the common causes of primary or referred eye pain.
Diplopia in a Child: Gradenigo Syndrome Is an Unforgettable Disease
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