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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
PubMed

Insights

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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