PDF(Pubmed)
Abstract：
Gradenigo\'s syndrome (GS) is a rare entity characterized by otitis media, pain in the trigeminal nerve distribution and abducens nerve palsy. The classic triad is uncommon, making the diagnostic workup challenging. Specifically, the diagnostic approach includes medical history, a complete otorhinolaryngological examination, a pure-tone audiogram and radiological investigation such as contrast-enhanced computed tomography scan and magnetic resonance imaging of head and neck. Broad-spectrum antibiotics are the first-line treatment, such as intravenous (IV) ceftriaxone and IV metronidazole. Here, we present the case of a 71-year-old man with a previous history of otitis media and poorly controlled type 2 diabetes mellitus. He presented to our attention with facial pain, left hemilarynx paralysis, dysphagia and otorrhea. The patient was treated with broad-spectrum antibiotics without any clinical improvement. Imaging evaluations demonstrated the presence of wide and poorly defined pathological material with epicenter in the masticatory space, involving all nearby structures. The patient underwent multiple biopsies without obtaining a definitive tissue diagnosis of neoplasia. After 2 months, the patient developed delayed VI cranial nerve palsy, providing evidence of GS. Although incomplete, GS has been described in the literature; however, none of the cases exhibited a latent abducent deficit. To the best of our knowledge, this is the only case with a delayed onset of abducens nerve palsy.
摘要：
Gradenigo综合征（GS）是一种罕见的以中耳炎为特征的实体，三叉神经分布疼痛和外展神经麻痹。经典的三合会并不常见,使诊断工作具有挑战性。具体来说,诊断方法包括病史，完整的耳鼻咽喉科检查,纯音听力图和放射学检查，如对比增强计算机断层扫描和头颈部磁共振成像。广谱抗生素是一线治疗,如静脉注射(IV)头孢曲松和IV甲硝唑。这里,我们介绍一例71岁男性患者,既往有中耳炎病史,2型糖尿病控制不佳.他面部疼痛引起了我们的注意，左半喉麻痹,吞咽困难和耳漏。患者接受广谱抗生素治疗，无任何临床改善。影像学评估表明，咀嚼空间中存在广泛且定义不清的病理材料，涉及所有附近的结构。患者接受了多次活检，但未获得明确的肿瘤组织诊断。两个月后,患者出现迟发性VI颅神经麻痹,提供GS的证据。虽然不完整，GS已在文献中描述；然而，没有一个病例表现出潜在的外展缺陷。据我们所知,这是唯一一例外展神经麻痹延迟发作的病例。
