Gradenigo syndrome also known as apical petrositis is a clinical triad of otitis media, trigeminal neuralgia and ipsilateral abducens nerve palsy. Clinically characterised by triad of ear discharge, diplopia, hemifacial pain. Gradenigo s syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy. In fact, of the original 57 cases described by gradenigo, less than half presented with the complete triad. Dorello replied with another note 12 challenging gradenigos criticism and alleged convincing topics.
Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. Sua ocorrencia esta relacionada ao acometimento do apice da parte petrosa do osso temporal e estruturas. Gradenigo syndrome also known as apical petrositis is a clinical triad of otitis media, trigeminal neural gia and ipsilateral abducens nerve palsy. Pdf gradenigos syndrome secondary to chronic otitis. Management of gradenigo syndrome in a child american journal. Gradenigo s syndrome gradenigo s syndrome tornabene, stephen. Gradenigo syndrome is clinically represented by the triad of otitis media, ipsilateral abducens nerve palsy and dysasthesia within the v1 and v2 divisions of the trigeminal nerve branches. Gradenigos syndrome definition of gradenigos syndrome. The italian author gradenigo was the first to establish as a clinical entity the syndrome which bears his name. Synonyms for gradenigo s syndrome in free thesaurus. Tratamento conservador da conservative treatment of. Gradenigo syndrome is a rare presentation of acute petrositis characterized by medial otitis.
In 1904, giuseppe gradenigo published his case series on the triad of ipsilateral abducens nerve palsy, facial pain in the trigeminal nerve distribution, and suppurative otitis media, which would subsequently be referred to as gradenigo syndrome 1, 2. Knowledge of the aetiology and appropriate investigations can lead to early diagnosis. Kantas i, papadopoulou a, balatsouras dg, aspris a, marangos n. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Gradenigo syndrome consists of the triad of petrous apicitis. Although rarer in the antibiotic era, this syndrome may be lifethreatening and highly morbid if. This is the only case described in the literature of carotid canal bone erosion in an adult patient with gs as a complication of otitis media. A syndrome characterised by ipsilateral paralysis of the abducens nerve sixth cranial nerve, severe pain in the area supplied by the ophthalmic branch of the trigeminal nerve fifth cranial nerve, and an intercurrent inflammatory diseases of the inner ear, mastoid sinus, or both. The syndrome can be associated with serious sequelae including death from meningitis. However, the underlying pathological process apical petrositis still represents a lifethreatening condition. Sua ocorrencia esta relacionada ao acometimento do apice da parte petrosa do osso temporal e estruturas vizinhas a. The symptoms of meningitis which include fever, headache, photophobia and irritability along with abducens nerve palsy pose a diagnostic. Suspicion of gradenigo s syndrome gs is essential since early treatment is required to prevent permanent sequelae.
Gradenigo syndrome petrous apicitis or petrositis is a rare complication of otitis media that if left unrecognized and subsequently untreated will result in severe neurologic sequelae. Shwannomimeningiomicarcinomi rinofaringeineurinomi processi infettivi, meningiti emicrania. Deficit bilateraledellabduzione aneurismi intracavernosi e fistola carotido cavernosa neoplasie. Acute otitis media complications are less and less common, thanks to the more widespread availability and use of adequate antibiotics. Chronic suppurative otitis media csom has a potential for intratemporal complications. Gradenigo s syndrome is an uncommon triad of retroorbital pain, diplopia due to 6th nerve palsy, and otorrhea due to otitis media and petrous apicitis. Gradenigos syndrome synonyms, gradenigos syndrome antonyms. Gradenigos syndrome as a first manifestation of rhabdomyosarcoma. Gradenigo syndrome is a very rare complication of otitis media that if left unrecognized and subsequently untreated will result in severe neurologic sequelae.
Gradenigos syndrome, journal of emergency medicine 10. Gradenigos syndrome is a complication of an otitis media infection and mastoiditis, involving three distinct manifestations. Gradenigo syndromeotitis mediamastoiditisapical petrositismeningitis. Gradenigos syndrome is an uncommon triad of retroorbital pain, diplopia. Gradenigo syndrome otitis media mastoiditis petrous apex ear discharge diplopia hemifacial pain, gradenigo s syndrome imaging findings, gradenigo s syndrome mri, trigeminal abducens nerve involvement.
In 1904, giuseppe gradenigo published his case series on the triad of ipsilateral abducens nerve palsy, facial pain in the trigeminal nerve. A triad of retroocular pain, discharging ear and abducens nerve palsy, as described by gradenigo, has been recognized for 150 years. Gradenigos syndrome with abscess of the petrous apex in. He soon became a pupil to adam politzer and samuel leopold schenk in vienna, demonstrating genuine interest in the embryology, morphology, physiopathology, as well as the clinical manifestations of ear diseases. Gradenigos syndrome, also called gradenigolannois syndrome, is a complication of otitis. Gradenigos syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Gradenigo syndrome without acute otitis media sciencedirect. Gradenigo s syndrome, also called gradenigo lannois syndrome, is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. In the era of antibiotic therapy, it is an exceptional but potentially life threatening complication of acute otitis media, requiring prompt diagnosis and treatment. Involvement of the petrous portion of the left temporal bone was demonstrated by ct and an inflammatory lesion of the left petrous apex was clearly shown by mri, which is useful in diagnosis and management of apical petrositis.
It has traditionally been treated with surgery, but recent advances in imaging, allied with improved antibiotic treatment, allow conservative management of these cases. The full text of this article is available as a pdf 89k. Gradenigos syndrome definition of gradenigos syndrome by. Gradenigo s syndrome, which is characterised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy may give rise to potentially fatal complications. On the other hand, gradenigo 11 adamantly criticized dorellos work, maintaining that his idea was not based on fact, neither clinical nor anatomical. Since the advent of antibiotics, the incidence of this potentially lifethreatening complication has diminished, but. Giuseppe gradenigo 18591926, a legendary figure of otology, was born in venice, italy. We report the case of an 8yearold girl with gradenigo s syndrome.
Sindrome di gradenigo mastoidite dellarocca petrosa deficit abducente dolore facciale e oculare paralisi facciale. Gradenigo s syndrome gs was first described by giuseppe gradenigo in 1904 when he reported a triad of symptoms consisting of periorbital unilateral pain related to trigeminal nerve involvement, diplopia due to sixth nerve palsy and persistent otorrhea, associated with bacterial otitis media with apex involvement of the petrous part of the temporal bone petrositis. Gradenigo s syndrome was firstly described in 1907 by giusseppe gradenigo and is defined as the clinical triad of suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the first and the second branches of the trigeminal nerve. Gradenigo syndrome, lateral sinus thrombosis and cavernous sinus. Gradenigo s syndrome is defined by the classic clinical triad of ear discharge, trigeminal pain, and abducens nerve palsy. In gradenigo s opinion, this was due to the limited areas of leptomeningitis both purulent and serous, triggered by the inflammatory process of the cavum tympani. Nevertheless, when they occur, they may be inconspicuous or silent but with dangerous evolution. Gradenigos syndrome, which is characterised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and. Nobody contested the value of this syndrome, but fierce discussions arose concerning the pathogenesis of the involvement of the vi cranial nerve. Described here is the case of a 5yearold child suffering from incomplete gradenigo syndrome without acute otitis media, which was.
Its recognition is important to prevent intracranial complications. Gradenigos syndrome, which is charac terised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve. It has become a very rare nosological entity after the introduction of antibiotics, so that has been defined as the forgotten syndrome. Both were female and one had bilateral involvement. The triad of gradenigo syndrome includes otorrhea, retroorbital pain and abducens nerve palsy. A rare complication of otitis media and mastoiditis involving petrous apex of temporal bone. It is often the result of chronic otitis media with longstanding purulent otorrhea. Gradenigos syndrome, which is characterised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy.264 235 1013 421 1296 660 459 1292 922 1450 872 63 546 1451 826 746 1057 272 225 689 957 1116 754 188 928 266 11 1502 130 1441 1305 1151 589 1274 1478 1382 761