Kristenson Scott, Jackson Adam, Mendoza Yolanda M, Fullmer Christina, Boldt Brian
Madigan Army Medical Center, 9040A Jackson Avenue, Tacoma WA 98431, USA.
Radiol Case Rep. 2020 Jul 4;15(9):1512-1517. doi: 10.1016/j.radcr.2020.05.069. eCollection 2020 Sep.
Central skull base osteomyelitis is a rare entity that can demonstrate confounding radiologic, clinical, and laboratory data leading to a delay in diagnosis. The morbidity and mortality for skull base osteomyelitis are both high, thus a rapid diagnosis is required for appropriate treatment. In this case report, we discuss a 68-year-old male who presented with acute left facial nerve paralysis in the setting of chronic headache and left mucoid middle ear effusion. Radiologic evaluation revealed abnormal hypointense marrow of the central skull base on T1 weighted magnetic resonance imaging, preclival mass-like tissue, and short segment luminal narrowing of the left cervical ICA with mycotic aneurysm formation. Extensive workup via a multidisciplinary approach, including neurology, otolaryngology, neurosurgery and radiology led to a diagnosis of central skull base osteomyelitis. A familiarity of this disease process is important for the radiologist in order to facilitate appropriate patient referral and treatment. This case emphasizes the importance of considering this diagnosis in the setting of headache, cranial neuropathy, and abnormal skull base imaging with adjacent preclival soft tissue mass.
中央颅底骨髓炎是一种罕见的疾病，其影像学、临床和实验室数据可能相互混淆，导致诊断延迟。颅底骨髓炎的发病率和死亡率都很高，因此需要快速诊断以便进行适当治疗。在本病例报告中，我们讨论了一名68岁男性，他在慢性头痛和左侧黏液性中耳积液的情况下出现急性左侧面神经麻痹。影像学评估显示，在T1加权磁共振成像上，中央颅底骨髓呈异常低信号，斜坡前有肿块样组织，左侧颈内动脉短节段管腔狭窄并形成霉菌性动脉瘤。通过多学科方法进行广泛检查，包括神经内科、耳鼻喉科、神经外科和放射科，最终诊断为中央颅底骨髓炎。放射科医生熟悉这种疾病过程对于促进适当的患者转诊和治疗很重要。本病例强调了在头痛、颅神经病变以及颅底成像异常并伴有斜坡前软组织肿块的情况下考虑这一诊断的重要性。
