Gradenigo syndrome and acute disseminated encephalomyelitis: An infective and inflammatory combo

Abstract

A 14 year old male presented with complaints of giddiness for two days.He had a history of left sided ear pain and a purulent discharge from the left ear one month ago. He had signs of cerebellar ataxia.On examining his left ear three point tenderness and tragal tenderness was present. On Day 4 he developed diplopia, facial pain and a GCS of 15/15. On examination he revealed a left lateral rectus palsy. CT Brain showed no evidence of raised intracranial tension. MRI Brain showed evidence of encephalitis. A cerbrospinal fluid analysis was within normal limits. The patient was suspected with Acute Disseminated Encephalomyelitis (ADEM) following otitis media of the left ear with an active episode of mastoiditis causing Gradenigo syndrome. Patient was treated with intravenous antibiotics, steroids and his condition improved.: Acute meningoencephalitis and Acute Disseminated Encephalomyelitis need to differentiated at the earliest to facilitate a faster recovery and aslo to minimize the neurological deficits. Combination of an infectious and inflammatory pathology can pose a serious problem.