Gradenigo's syndrome, otherwise referred to as Gradenigo-Lannois syndrome and petrous apicitis, primarily arises as a complication following a case of otitis media infection and inflammation of the mastoid air cells of the temporal bone, that has extended to the petrous temporal bone [1] [2]. Its typical presentation involves pain that follows the distribution of the trigeminal nerve (5th cranial nerve), alongside palsy of the abducens nerve (6th cranial nerve) and otorrhea, the latter resulting from an otitis media infection [3]. Even though the aforementioned triad is considered to be the classical presentation of Gradenigo's syndrome, clinical characteristics of the infection are often diverse; photophobia, fever, excessive secretion of tears and a diminished corneal sensitivity may further complicate the clinical picture. Patients may also present with persistent headaches and some studies even report symptomatology consistent with facial and vestibulocochlear nerve pathology [4]. If left misdiagnosed or untreated, Gradenigo's syndrome can lead to serious neurological complications and death [5].

Given that Gradenigo's syndrome occurs as a complication of an original otitis media infection that has extended to involve the apex of the petrous temporal bone, the syndrome is currently considered a rare medical entity, since antibiotics started to be used in daily clinical practice.

• Fever

  In addition, other symptoms may include: involvement of the facial nerve and vestibulocochlear nerve 5 photophobia fever excessive lacrimation Further spread of infection may give rise to complications, including: intracranial abscess meningitis skull [radiopaedia.org]

  CASE REPORT: PHLS, 2 years, masculine sex, directed for pediatrician with picture of hyaline rhinorrhea, fever, otalgia to the right have 8 days without improvement with use of the amoxicilina. [arquivosdeorl.org.br]

  When a child presents with fever, headache and photophobia, central nervous system infections should be excluded. [bmcpediatr.biomedcentral.com]

  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. [ncbi.nlm.nih.gov]

  Case presentation We report a case of a 3-year-old girl, who presented with fever and left-sided acute otitis media. [bmcearnosethroatdisord.biomedcentral.com]

• Sepsis

  Chemotherapy regiment was started, but about 4 months later patient expired due to fulminant sepsis. Figure 1. [zjrms.com]

  CRS, line sepsis カテーテル尿 catheter urine カナマイシン kanamycin KM カービー -バウアー法試験紙 Kirby-Bauer Disks カプレオマイシン capreomycin CPRM カポジ水痘様発疹症 Kaposi's varicelli form eruption カポジ肉腫 Kaposi's sarcoma KS カラ アザール Kala-azar カリエス caries カリニ肺炎 pneumocystis carinii pneumonia [docsplayer.net]

  2018 2019 Billable/Specific Code Applicable To Acanthocephaliasis Gongylonemiasis Hepatic capillariasis Metastrongyliasis Thelaziasis Goniosynechiae - see Adhesions, iris, goniosynechiae Gonococcemia A54.86 ICD-10-CM Diagnosis Code A54.86 Gonococcal sepsis [icd10data.com]

  同 semicircular duct 半規管 " 半規管膨大部 半月裂孔 感覚レベル 同 susceptibility test, resistance test 抗菌薬感受性試験 " 感作 感音難聴 同 Wernicke aphasia 感覚失語 " 感覚細胞 S １ １ ４ sen S sensory epithelium 感覚上皮 sensory hair 感覚毛 sentence intelligibility 文章了解度 sentinel lymph node センチネルリンパ節 sepsis [upslide.site]

• Malaise

  He did not have nausea, vomiting, malaise or seizures. There was no ear pain or hearing loss. He had been taking oral cefuroxime prescribed by a general practitioner for the febrile illness during previous 5 days. [bmcpediatr.biomedcentral.com]

  Fever and malaise precede neurological findings. The initial localising features are unilateral chemosis, periorbital oedema, and eyelid swelling. As retrobulbar pressure increases, ophthalmoplegia and exophthalmus ensue. [jnnp.bmj.com]

• Pneumonia

  Cerebrospinal fluid (CSF) culture results were positive for Klebsiella pneumoniae, sensitive to ceftriaxone. [ncbi.nlm.nih.gov]

  Discussion S. pneumoniae is a common pathogen implicated in both otitis media and meningitis. Given temporal bone erosion in figure 1, it is likely that meningitis was initially caused by petrositis. [karger.com]

  Despite the administration of high dose antibiotics the patient soon went on to develop stigmata of Vernet's syndrome (that is, involvement of IX, X, XI cranial nerves) followed by aspiration pneumonia. [doi.org]

  Our final diagnoses were Gradenigo syndrome and cavitary pneumonia secondary to Actinomyces infection and F nucleatum–Parvimonas coinfection. [academic.oup.com]

• Eruptions

  交差反応 cross reaction 交叉反応性 cross-reactivity 交差免疫電気泳動 [ 法 ] counter immunoelectrophoresis CIE 厚生労働省 Ministry of Health, Labour and Welfare 光学顕微鏡 light microscope 光学密度 optical density OD 光線過敏症 photodermatosis, photosensitivity 光線過敏性薬疹 photosensitive drug eruption [docsplayer.net]

• Otalgia

  The middle ear and mastoid rhabdomyosarcoma may present a large variety of signs and symptoms, including facial paralysis, otorrhea, otalgia etc. (5). [arquivosdeorl.org.br]

  Full Text A male aged 41 presented with a one-month duration of otalgia and deafness in the right ear, which was later associated with binocular diplopia, fever and slight non fetid whitish discharge from the ear. [elsevier.es]

  A 45-years-old man initially complained of right otalgia and trigeminal neuralgia, while right abducens nerve paralysis appeared about two weeks after onset of acute otitis media. A CT scan showed an extradural abscess in the right petrous apex. [jstage.jst.go.jp]

• Tinnitus

  […] syndrome References: [8] Cerebellopontine angle syndrome Etiology : : most commonly vestibular schwannomas ( acoustic neuroma ), although other cerebellopontine angle tumors may result in the same presentation Clinical features Unilateral hearing loss Tinnitus [amboss.com]

  […] tympanic branch of the glossopharyngeal nerve (Jacobson's nerve) within the middle ear cavity Glomus jugulare - arise from paraganglia along the auricular branch of the vagus nerve (nerve of Arnold) in the jugular fossa Patients present with pulsatile tinnitus [spinwarp.ucsd.edu]

  A History of Tinnitus. Tinnitus handbook. San Diego, CA: Singular Thomson Learning; 2000. p. 437-48 37. Stephens D, Orzan E. Galleti Di San Cataldo F: Giuseppe Gradenigo and his contributions to audiology. J Laryngol Otol. 1997. 111: 418-23 38. [surgicalneurologyint.com]

  Progressive sensorineural hearing loss is the most common presenting symptom often associated with high pitched tinnitus. Tinnitus often subsides as hearing loss progresses to complete deafness. [jnnp.bmj.com]

  病期分類 シュタール耳 歩行異常 標準失語症検査 標準マイクロホン 標準聴覚閾値 定在波 アブミ骨摘出術 アブミ骨神経 同 stapedius reflex アブミ骨筋反射 " ear）reflex stapedial tinnitus アブミ骨筋性耳鳴 stapedius（muscle）tendon アブミ骨筋腱 類 acoustic（middle ! [upslide.site]

• Benign Paroxysmal Positional Vertigo

  […] mesothelioma benign paroxysmal positional nystagmus benign paroxysmal positional vertigo Bernoulli effect Bertin cartilage best frequency Bezold abscess bias component Bill’s bar binasal hemianopia binaural discrimination binaural fusion binaural hearing [upslide.site]

• Strabismus

  New Fifth Edition chapters cover Neonatal Ophthalmology, Surgical Management of Strabismus, Medicolegal Issues, and Evolution of Strabismus Surgery. [books.google.com]

  Strabismus. 2016;24(1):21-7. doi: 10.3109/09273972.2015.1130067. Epub 2016 Mar 16. Strabismus. 2016. PMID: 26979620 Review. Gradenigo's syndrome: is fusobacterium different? Two cases and review of the literature. [pubmed.ncbi.nlm.nih.gov]

  Left convergent strabismus was evident with abduction impairment of the same eye. [scielo.mec.pt]

  Other ocular findings in patients with Down Syndrome: cataracts, IOP, myopia, strabismus Demographics: occurs more frequently in Caucasians and in those with light irides. Kathleen Curtin, BS [michiganorthopticprogram.com]

  Diagnosis of Peripheral Ocular Motor Palsies and strabismus. Ch 9;385-474. In: The Neurology of Eye Movements 4th Edition, Oxford University Press, New York 2006. 2. Sherman SC, Buchanan A. [collections.lib.utah.edu]

• Lacrimation

  In addition, other symptoms may include: involvement of the facial nerve and vestibulocochlear nerve 5 photophobia fever excessive lacrimation Further spread of infection may give rise to complications, including: intracranial abscess meningitis skull [radiopaedia.org]

  Other principal symptoms are photphobia, excessive lacrimation, fever, and reduced corneal sensitivity. The Gradenigo triad consists of otitis, abducens paralysis, and deep pain. [whonamedit.com]

  […] supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), Diplopia - ipsilateral paralysis of the abducens nerve (sixth cranial nerve), and Persistent Ear Discharge - otitis media Other symptoms can include photophobia, excessive lacrimation [wikidoc.org]

  Other symptoms can include photophobia, excessive lacrimation, fever, and reduced corneal sensitivity. The syndrome is usually caused by the spread of an infection into the petrous apex of the temporal bone. [ipfs.io]

  […] syndrome include: retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), abducens nerve palsy (sixth cranial nerve)[4] otitis media Other symptoms can include photophobia, excessive lacrimation [en.wikipedia.org]

• Photophobia

  In addition, other symptoms may include: involvement of the facial nerve and vestibulocochlear nerve 5 photophobia fever excessive lacrimation Further spread of infection may give rise to complications, including: intracranial abscess meningitis skull [radiopaedia.org]

  When a child presents with fever, headache and photophobia, central nervous system infections should be excluded. [bmcpediatr.biomedcentral.com]

  Retro-orbital pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), Diplopia - ipsilateral paralysis of the abducens nerve (sixth cranial nerve), and Persistent Ear Discharge - otitis media Other symptoms can include photophobia [wikidoc.org]

  The next day, she was taken to another emergency room where she manifested photophobia, phonophobia, nausea, vomiting, neck stiffness, and severe headache. [karger.com]

  Other symptoms can include photophobia, excessive lacrimation, fever, and reduced corneal sensitivity. The syndrome is usually caused by the spread of an infection into the petrous apex of the temporal bone. [ipfs.io]

• Eye Pain

  He also complained of headache, left eye pain and photophobia for the same duration and double vision for 2 days. He did not have nausea, vomiting, malaise or seizures. There was no ear pain or hearing loss. [bmcpediatr.biomedcentral.com]

  Eye findings may include inflammation of the uvea (uveitis), red eyes, eye pain, eye irritation, photophobia, and vision or refractive error changes. There are several categories of JIA. [michiganorthopticprogram.com]

  […] movement eye pain eye tracking test 同 cholesteatoma of external auditory canal 外耳道真珠腫 ! [upslide.site]

• Blepharitis

  The ocular findings in individuals with Down syndrome include refractive errors, astigmatism, strabismus, nystagmus, amblyopia, cataracts, glaucoma, Brushfield spots, blepharitis, lacrimal obstructions, and corneal ectasias. [michiganorthopticprogram.com]

  […] arginine deiminase アルテルナリア症 alternariasis アルブミン albumin Alb アルベカシン arbekacin ABK (HBK) アレルギー allergy 即時型アレルギー immediate type allergy 遅延型アレルギー delayed type allergy 光アレルギー photo allergy ペニシリンアレルギー penicillin allergy 薬物アレルギー drug allergy アレルギー性眼瞼炎 allergic blepharitis [docsplayer.net]

• Facial Pain

  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. [ncbi.nlm.nih.gov]

  Inflammation in this region can damage these nerves, causing facial pain and horizontal diplopia secondary to unilateral esotropia. [eyewiki.aao.org]

• Headache

  A triad of Otitis media, left hemi cranial headache and left lateral rectus palsy consistent with Gradenigo's syndrome. [neuroradiologycases.com]

  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. [ncbi.nlm.nih.gov]

  Gra·de·ni·go syn·drome ( grah-dā'nē-go ), a syndrome consisting of otorrhea, headache, diplopia, and retroorbital pain in petrositis due to an epidural abscess at the apex of the anterior surface of the petrous pyramid causing compression of the abducens [medical-dictionary.thefreedictionary.com]

• Trigeminal Neuralgia

  Trigeminal nerve (5th CN) involvement explains Trigeminal neuralgia - pain in the distribution of the trigeminal nerve manifest with hemicranial headache, hemi facial pain. 3. [neuroradiologycases.com]

  The clinical picture is of general interest, as the pain is in the form of a trigeminal neuralgia, except that it is limited to the first division of the fifth nerve and may persist for weeks or months after the discharge from the ear has ceased. [jamanetwork.com]

  A 45-years-old man initially complained of right otalgia and trigeminal neuralgia, while right abducens nerve paralysis appeared about two weeks after onset of acute otitis media. A CT scan showed an extradural abscess in the right petrous apex. [jstage.jst.go.jp]

  Background: Gradenigo´s Syndrome usually appears as a complication of the suppurative otitis media and its triad consists of acute otitis media, trigeminal neuralgia and sixth cranial nerve palsy. [jns-journal.com]

• Nystagmus

  […] optokinetic nystagmus pattern optokinetic nystagmus pattern test optokinetic nystagmus test optokinetic reflex oral administration oral allergy syndrome 膨大細胞腫，好酸性細胞腺腫，好酸性顆粒細胞腫 癌遺伝子 同 paralytic pontine exotropia ワンアンドハーフ症候群 " 同 sphenoethomidal cell オノディ [upslide.site]

  Ocular motility: No ptosis No exophthalmos Full eye movements right eye (OD) Esotropia (24 diopters) in primary gaze left eye (OS) Limitation of full abduction OS Normal convergence No nystagmus Normal corneal reflexes Lower cranial nerves normal Neurological [collections.lib.utah.edu]

  Other findings may include strabismus, upshoots and downshoots of affected eye, A or V patterns, a face turn toward the affected side, enophthalmos, ptosis, heterochromia, nystagmus, and hypoplasia of the optic nerve. [michiganorthopticprogram.com]

  The eye movement disorder of downbeat nystagmus is highly site specific. Cough headache and transient cough leg weakness suggest a “tight” or “crowded” foramen. [jnnp.bmj.com]

  眼窩尖端症候群 orbital apex syndrome 眼窩膿瘍 orbital abscess 眼窩蜂巣炎 orbital phlegmon[e] 眼感染 [ 症 ] ocular infection, eye infection 眼球突出 exophthalmos 眼結核 ocular tuberculosis 眼瞼炎 blepharitis 眼瞼膿瘍 eyelid abscess, palpebral abscess 眼瞼皮膚炎 dermatitis of eyelid 眼振 ( 眼球振盪 ) nystagmus [docsplayer.net]

The first step towards a precise diagnosis of Gradenigo's syndrome is a complete medical history, involving symptomatology and duration thereof and a confirmation of a recent or chronic otitis media infection. Manifestations that include an abducens nerve palsy, pain along the distribution of the trigeminal nerve and an otitis media infection that also involves the discharge of pus greatly direct suspicion towards Gradenigo's syndrome.

Imaging modalities that are used to diagnose the syndrome encompass a computerized tomography scan (CT scan) and a magnetic resonance imaging scan (MRI scan) of the temporal bone. The former usually illustrates hypodensity in the region of the petrous apex; the latter is expected to display hyperintensity on T2-weighted images and hypointensity on T1-weighted images. The infected region is enhanced in both the CT and the MRI scan. An MRI scan can also exhibit the pathology that underlies Gradenigo's syndrome and can range between cholesteatomas, malignant tumors, inflammatory granulomas and osteomyelitis [6] [7]. A single study also implemented diffusion-weighted MRI to aid in the depiction of abscesses and cholesteatomas in regions where diffusion is limited [6].

The differential diagnosis of Gradenigo's syndrome also entails various other pathologies that can assume the same symptomatology. Nasopharyngeal carcinoma and lymphoma of the petrous bone are two conditions whose symptomatology can greatly resemble that of Gradenigo's syndrome. Attention should be brought to the possibility of afebrile, non-otological manifestations after infectious petrositis, which could be misdiagnosed as a malignancy, with the consequence of antimicrobial treatment postponement influencing the prognosis [8].

Treatment and prognosis The mainstay of treatment is antibiotic therapy 4. Rare cases may require surgical intervention. [radiopaedia.org]

Although there is little evidence to support the use of medical therapy in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome following chronic otitis [ncbi.nlm.nih.gov]

Diagnosis confirmed by X-Ray (Towne's View & Stenver's View) and by CT Scan of Temporal bone Treatment - Cortical (or) Modified Radical (or) Radical Mastoidectomy. [wikidoc.org]

The authors describe in this article the case of a 7 year-old boy with this syndrome treated successfully with conservative treatment instead of surgical treatment. Keywords : Gradenigo's syndrome; petrositis; abducens palsy. [scielo.br]

Treatment and prognosis The mainstay of treatment is antibiotic therapy 4. Rare cases may require surgical intervention. [radiopaedia.org]

Attention should be brought to the possibility of afebrile, non-otological manifestations after infectious petrositis, which could be misdiagnosed as a malignancy, with the consequence of antimicrobial treatment postponement influencing the prognosis. [symptoma.com]

Prognosis Formerly, the prognosis was very poor with death a common occurrence. [patient.info]

A clinical study comprising 124 cases with special reference to clinical presentation and prognosis. Neurosurg Rev 1998;21:243-8. [Figure 1], [Figure 2] [cancerjournal.net]

Improved prognosis with intensive treatment of children with cranial soft tissue sarcomas arising in nonorbital parameningeal sites. A report from the Intergroup Rhabdomyosarcoma Study. Cancer. 1987, 59:1846-1902. 12. [arquivosdeorl.org.br]

The last case was a Gradenigo-Lannois syndrome, and its etiology, either chronic otitis or sphenoidal sinusitis, is discussed. [ncbi.nlm.nih.gov]

The most common etiology of this syndrome is an infection.[2] We reported a case that differs from these published reports: An NPC the etiology of Gradenigo's syndrome; the presence of recurrent symptoms of the syndrome persisted in a patient. > Case [cancerjournal.net]

[…] to the trigeminal nerve References: [1] [2] Foster-Kennedy syndrome Orbital apex syndrome Cavernous sinus syndrome Etiology Cavernous sinus thrombosis (e.g., due to sinusitis ) Carotid-cavernous fistula Cavernous sinus tumors Carotid artery aneurysms [amboss.com]

The original reference is provided for historical interest, and review articles are included to show recent advances in etiology and treatment. [books.google.de]

An awareness of its existence and appropriate levels of suspicion of the condition are necessary to prevent severe damage or death in those affected. [ 2, 3 ] Epidemiology There are no reliable recent figures. [patient.info]

Epidemiology Frequency Petrous apicitis was commonly encountered before the introduction of antibiotics. It now appears quite rarely. [emedicine.medscape.com]

壊死性胆嚢炎 necrotizing cholecystitis 壊死性腸炎 necrotizing enteritis(enterocolitis) 壊死性リンパ節炎 necrotizing lymphadenitis 壊疽 gangrene ガス壊疽 gas gangrene 糖尿病性壊疽 diabetic gangrene フルニエール壊疽 Fournier's gangrene 壊疽性口内炎 gangrenous stomatitis 衛星現象 satellite phenomenon 疫学 epidemiology [docsplayer.net]

The pathophysiology, therapy and differential diagnosis of this syndrome, which has become rare since the introduction of antibiotics, are discussed. [ncbi.nlm.nih.gov]

We hope to add new information to the existing literature and to aid in the understanding of the pathophysiology and management of this condition. [tandfonline.com]

Pathophysiology Caused by extension of an infection of the middle ear, mastoid sinus, or both to the petrous apex that occurs because of extensive pneumatization and the presence of bone marrow. [accesspediatrics.mhmedical.com]

The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25(1), 1-35. ‎ Pagina 52 - In: Wall PD, Melzack R (eds), Textbook of pain. Churchill Livingstone, Edinburgh... ‎ [books.google.it]

Gradenigo classically described the following as the classic features of this syndrome: Discharging ear Retro orbital pain Adbucent nerve paralysis causing diplopia Causative factors: Uncontrolled mastoiditis Epidural abscess following mastoiditis Pathophysiology [drtbalu.co.in]

Early recognition of condition is important to prevent intracranial complications like Meningitis, Intracranial abscess, Spread to skull base and involvement of IX, X, XI cranial nerves (Vernet’s syndrome), Prevertebral/parapharyngeal abscess, Spread [neuroradiologycases.com]

There is little evidence to support increased use of antibiotics in acute otitis media to prevent this complication. [ncbi.nlm.nih.gov]

Suspicion of Gradenigo's syndrome (GS) is essential since early treatment is required to prevent permanent sequelae. [elsevier.es]

Timely management with intravenous antibiotics (± surgery) is needed to prevent intra-cranial complications. Keywords: Gradenigo’s syndrome, Earache, Retro-orbital pain. Introduction Otitis media is a common disease involving children. [jpma.org.pk]

1. Devic M, Boucher M, Raveau M. Some cases of Gradenigo-Lannois syndrome. Journal de médecine de Lyon. 1996;47 (96):537–547.
2. Bléry M, Chagnon S, Picard A, Babin C. Cranial osteitis: a report on four cases, including a Gradenigo-Lannois syndrome (author's transl). Journal de radiologie. 1980;61(11):677–681.
3. Motamed M, Kalan A. Gradenigo's syndrome. Postgraduate medical journal.2000;76(899):559-560.
4. Sherman SC, Buchanan A. Gradenigo syndrome: a case report and review of a rare complication of otitis media. J Emerg Med. 2004;27:253–256.
5. Valles JM, Fekete R. Gradenigo Syndrome: Unusual Consequence of Otitis Media. Case Rep Neurol. 2014;6(2):197–201.
6. Ibrahim M, Shah G, Parmar H. Diffusion-weighted MRI identifies petrous apex abscess in Gradenigo syndrome. J Neuroophthalmol. 2010;30:34–36.
7. Pedroso JL, de Aquino CC, Abrahão A, et al. Gradenigo's Syndrome: Beyond the Classical Triad of Diplopia, Facial Pain and Otorrhea. Case Rep Neurol. 2011;3:45–47.
8. Yoong HS, Kiaang TK. Gradenigo's syndrome presenting as a tumor. Otolaryngol Head Neck Surg. 2006;135:821–822