Gradinego’s syndrome: atypical presentation

Abstract

Gradenigo’s syndrome was first described by Giuseppe Gradenigo in 1907 when he reported a triad of symptoms consisting of unilateral periorbital pain related to trigeminal nerve involvement, diplopia due to sixth cranial nerve palsy and persistent otorrhoea, associated with otitis media with petrositis. The classical syndrome related to otitis media has become very rare after the antibiotic era. Incomplete and atypical clinical features of Gradenigo’s syndrome have been described and non infectious causes may mimic this condition. We report a case of acute petrositis in a 19 year old boy with unilateral periorbital pain, diplopia (lateral rectus palsy) in the absence of ear discharge. Careful clinical history, physical examination, including neuroimaging, is necessary to make a differential diagnosis. Appropriate management requires antibiotic treatment and possible surgical intervention.