Brambilla Alice, Pasti Mattia, Parri Niccolò
From the: University of Florence.
Departments of Pediatrics.
Pediatr Emerg Care. 2019 Dec;35(12):e236-e237. doi: 10.1097/PEC.0000000000001684.
Otitis media, facial pain in trigeminal region, and ipsilateral abducens nerve palsy clinically define Gradenigo syndrome, a rare but serious complication of suppurative middle ear infection. Radiological investigation is required to confirm petrous apex involvement and to exclude further consequences as sinus thrombosis, meningitis, and intracranial abscess.
METHODS/RESULTS: We report the case of an 8-year-old child referred to our emergency department for recurrent headache and sudden strabismus. Clinical evidence of suppurative otitis media raised the suspicion for Gradenigo syndrome, definitively confirmed at computed tomography and magnetic resonance imaging scans. Conservative treatment alone enabled complete clinical and radiological remission, without long-term sequelae.
Despite being a rare condition, Gradenigo syndrome should be taken into account as potential differential diagnosis in children referred to emergency department for recurrent headache and strabismus. An accurate anamnesis to document recent ear infection is mandatory to orientate the diagnosis and focus radiological investigations. Early recognition and timely intervention may allow conservative management to succeed, avoiding the need for surgery and serious sequelae.
中耳炎、三叉神经区域面部疼痛以及同侧展神经麻痹在临床上定义为Gradenigo综合征，这是化脓性中耳感染的一种罕见但严重的并发症。需要进行影像学检查以确认岩尖受累情况，并排除如窦血栓形成、脑膜炎和颅内脓肿等进一步的后果。
方法/结果：我们报告了一名8岁儿童因反复头痛和突然斜视转诊至我们急诊科的病例。化脓性中耳炎的临床证据引发了对Gradenigo综合征的怀疑，计算机断层扫描和磁共振成像扫描最终确诊。仅采用保守治疗就实现了临床和影像学的完全缓解，且无长期后遗症。
尽管Gradenigo综合征较为罕见，但对于因反复头痛和斜视转诊至急诊科的儿童，应将其作为潜在的鉴别诊断加以考虑。准确记录近期耳部感染的病史对于明确诊断和指导影像学检查至关重要。早期识别和及时干预可能使保守治疗取得成功，避免手术及严重后遗症的需要。
