scholarly journals A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Haruka Miyabe ◽  
Atsuhiko Uno ◽  
Takahiro Nakajima ◽  
Natsue Morizane ◽  
Keisuke Enomoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Cranial Nerve ◽  
Initial Presentation ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Life Threatening ◽  
The Right

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence ofPseudomonas aeruginosain the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

scholarly journals A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Brijesh Patel ◽  
Anas Souqiyyeh ◽  
Ammar Ali
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Otitis Externa ◽  
Skull Bone ◽  
Topical Antibiotics ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
The Common

Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

scholarly journals Extensive skull base osteomyelitis, devastating complication of otitis externa: A case report and review of the literature

2021 ◽  
Vol 2 (3) ◽  
pp. 1-7
Author(s):  
Khadija El Bouhmadi ◽  
◽  
Myriam Loudghiri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Skull Base ◽  
Otitis Externa ◽  
Delayed Diagnosis ◽  
Petrous Bone ◽  
Term Treatment ◽  
Skull Base Osteomyelitis ◽  
Long Term Treatment ◽  
Orbital Wall ◽  
The Right

Skull base osteomyelitis (SBO), also referred to as malignant otitis externa (MOE) in its typical form, is usually a complication of otitis externa and severe uncommon and life-threatening condition requiring early diagnosis and long-term treatment in order to avoid its neurologic sequelae. We report the case of 69 years old female with a history of uncontrolled type 2 diabetes, who presented refractory and chronic right-sided purulent otorrhea with temporal headaches for 6 months, treated with no improvement by multiple attempts of ambulatory empiric therapy. After the appearance of grade III facial palsy and painful swelling in the right periorbital and zygomatic areas, the patient consulted in our department where a CT scan showed massive cortical and trabecular destruction of the right petrous bone and the mastoid extended to the lateral orbital wall, the zygomatic arch and the greater sphenoid wing realising extensive osteomyelitis of the skull base and the lateral face. The treatment was started immediately based on intravenous broad-spectrum antibiotics. Despite aggressive long-term treatment, the patient passed away, underlying the increased SBO morbidity and mortality secondary to delayed diagnosis.

Internal carotid artery aneurysm in skull base osteomyelitis: does the pattern of cranial nerve involvement matter?

2018 ◽  
Vol 132 (10) ◽  
pp. 929-931
Author(s):  
F Hassannia ◽  
S D Carr ◽  
E Yu ◽  
J A Rutka
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Cranial Nerve ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Carotid Artery Aneurysm ◽  
Nerve Involvement

AbstractObjectiveCarotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.MethodsTwo diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.ResultsInternal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.ConclusionOne should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

scholarly journals Clival Osteomyelitis Presenting as a Skull Base Mass

2017 ◽  
Vol 78 (02) ◽  
pp. e93-e95 ◽  
Author(s):  
Matthew Michalowicz ◽  
Murugappan Ramanathan
Keyword(s):  
Skull Base ◽  
External Auditory Canal ◽  
Cranial Nerve ◽  
Disease Entity ◽  
Radiographic Evidence ◽  
Skull Base Osteomyelitis ◽  
Radiologic Findings ◽  
Life Threatening

AbstractCentral skull base osteomyelitis is a rare, but potentially life-threatening disease entity often lacking otologic symptoms or external auditory canal pathology. We present a case of a man in his 70s who had developed cranial nerve deficits with radiographic evidence that was consistent with a tumor due to this uncommon entity. The radiologic findings and our experience are discussed to increase awareness in the otolaryngology community.

scholarly journals Atypical skull base osteomyelitis in the intensive care unit: A case report

2017 ◽  
Vol 5 (1) ◽  
pp. 15
Author(s):  
Pradeep Hiremath ◽  
Pradeep Rangappa ◽  
Ipe Jacob ◽  
Sriram Patwari ◽  
Karthik Rao
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Microbiological Analysis ◽  
Biopsy Material ◽  
Jugular Veins ◽  
Skull Base Osteomyelitis ◽  
Base Of Skull ◽  
Cranial Nerve Palsies ◽  
Magnetic Resonance Imaging Mri

Base of skull osteomyelitis is commonly seen as a complication of malignant otitis externa, involving the temporal bone. It initially presents with aural symptoms such as ear ache and discharge and cranial nerve palsies. We report an atypical presentation of skull base osteomyelitis that did not show signs of otitis externa. The patient presented with severe headache, drowsiness and signs of bulbar weakness including pooling of oropharyngeal secretions. Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) studies showed a bony erosion of the left side of base of skull involving the sphenoid bone and surrounding foramina, left sided coalescent mastoiditis and inflammation of the left parapharyngeal space. There was also inflammation of the tissues encasing the internal carotid artery and jugular veins and thrombosis of left jugular vein. These imaging findings along with cranial nerve palsies were suggestive of malignancy. However, tissue biopsy was negative for malignancy. The growth of Pseudomonas aeruginosa in the biopsy material as well as nasopharyngeal and blood cultures along with elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels led to a diagnosis of base of skull osteomyelitis. Hence diagnosis in such cases requires that biopsy material be sent for microbiological analysis, in addition to histology.

Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges in Atypical Presentation

2005 ◽  
Vol 133 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Amar Singh ◽  
Mazin Al Khabori
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Cranial Nerves ◽  
Contralateral Side ◽  
Lateral Sinus ◽  
Skull Base Osteomyelitis ◽  
Atypical Symptoms ◽  
Malignant Otitis Externa ◽  
Atypical Manifestations

OBJECTIVE: We sought to document the diagnostic and management difficulties in masked skull base osteomyelitis secondary to malignant otitis externa, with emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN: Retrospective analysis of 3 cases of inadequately treated malignant otitis externa in elderly diabetic individuals leading to recurrence and atypical manifestations of skull base osteomyelitis on contralateral side with or without multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the disease despite aggressive treatment. One case was treated successfully with combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric oxygen therapy. Major complications such as thrombosis of lateral sinus and internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine erosion and paralysis of all cranial nerves with exception of Ist cranial nerve were observed. CONCLUSION: There is high morbitity and mortality associated with skull base osteomyelitis. In partially treated cases of malignant otitis externa, atypical symptoms and findings of unilateral severe otalgia, unremitting headache, and presence of high ESR, unilateral OME, constitute diagnostic clues of skull base osteomyelitis. Such cases require further investigation with CT, MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

Sign in / Sign up

Export Citation Format

Share Document