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Published on: July 5, 2021

Sixth and tenth nerve palsy secondary to pseudomonas infection of the skull base

Sonalee Kulkarni1, Andrew Lee, John H Lee

  • 1Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP, Iowa City, IA 52242, USA. andrew-lee@uiowa.edu

American Journal of Ophthalmology
|April 30, 2005
PubMed
Abstract

Insights

Skull base osteomyelitis, a rare complication of chronic otitis media, can cause double vision (diplopia) due to nerve palsies. Early diagnosis and treatment are crucial to prevent lasting neurological damage.

Area of Science:

  • Otolaryngology
  • Neurology
  • Infectious Diseases

Background:

  • Skull base osteomyelitis is an uncommon complication of chronic otitis media.
  • This condition can manifest with neurological deficits, including cranial nerve palsies.
  • Its occurrence in the post-antibiotic era highlights the need for continued vigilance.

Observation:

  • A case report details a patient presenting with diplopia secondary to sixth and tenth cranial nerve palsies.
  • Diagnostic imaging, including MRI, bone scan, and gallium scan, was instrumental in identifying skull base osteomyelitis.
  • Cultures confirmed Pseudomonas as the causative pathogen.

Findings:

  • Pseudomonas skull base osteomyelitis can involve the clivus, leading to sixth nerve palsy.
  • The diagnosis was confirmed through a combination of clinical presentation and advanced imaging techniques.
  • Treatment involved prolonged intravenous antibiotic therapy.

Implications:

  • This case underscores that skull base osteomyelitis remains a potential cause of diplopia, even in the modern antibiotic era.
  • Prompt recognition and comprehensive diagnostic workup are essential for effective management.
  • Aggressive antibiotic treatment may prevent permanent neurological sequelae in patients with skull base osteomyelitis.

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