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A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction
Haruka Miyabe1, Atsuhiko Uno1, Takahiro Nakajima2
1Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Bandaihigashi 3-1-56, Sumiyoshi-ku, Osaka 558-8558, Japan.
Case Reports in Otolaryngology
|September 7, 2016
Summary
Skull base osteomyelitis can cause brain infarctions via artery-to-artery embolization. This case highlights internal carotid artery involvement, leading to cerebral infarctions and cranial nerve palsies in a patient with diabetes and renal failure.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Skull base osteomyelitis typically arises from malignant otitis externa.
- It often presents with aural symptoms and cranial nerve deficits.
Purpose of the Study:
- To report a rare case of skull base osteomyelitis presenting with cerebral infarctions.
- To investigate the potential role of internal carotid artery involvement in this presentation.
Main Methods:
- Case report of a 70-year-old male with diabetes and chronic renal failure.
- Utilized imaging studies (CT, MRI), laboratory tests (inflammation markers, cultures), and clinical examination.
- Monitored carotid artery blood flow and neurological status.
Main Results:
- The patient presented with left hemiparesis and multiple right cerebral infarctions.
- Initial carotid artery flow was maintained but occluded within 7 days; collateral supply mitigated severe infarction.
- Diagnosis of skull base osteomyelitis was confirmed by inflammation markers, Pseudomonas aeruginosa, cranial nerve palsies, bony erosion, and MRI findings.
- Successful treatment with antibiotics, complicated by cefepime-induced neurotoxicity.
Conclusions:
- Skull base osteomyelitis can manifest with cerebrovascular complications like artery-to-artery embolization.
- Internal carotid artery involvement is a critical consideration in the pathogenesis of skull base osteomyelitis.
- Prompt diagnosis and management are crucial for this life-threatening condition.
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