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Radiology Forum
June 2001

Diagnosis Quiz Case 2

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2001;127(6):716-717. doi:

In the preantibiotic era, spread of middle ear infection to the mastoid and petrous apex often resulted in serious intracranial complications, such as lateral or cavernous sinus thrombosis, meningitis, and death. In 1907, Gradenigo described the classic syndrome of otorrhea, diplopia, and retro-orbital pain, which he attributed to petrous apicitis. The clinical presentation of Gradenigo syndrome varies depending on the severity and extent of the infection within the petrous apex and its surrounding area. All components of Gradenigo syndrome may not be present in petrous apicitis, or patients may show deficits in cranial nerves II through X from extension to the skull base or cavernous sinus. Owing to the wide use of antibiotics, it can be difficult to diagnose petrous apicitis. Clinically, however, MRI and CT scans are often diagnostic.