Osteomyelitis of the skull base.
Three cases of osteomyelitis of the skull base with associated problems in diagnosis and therapy are discussed. Patients with atypical skull base osteomyelitis are difficult to diagnose as they have no ear abnormalities, but they often develop multiple cranial nerve deficits mimicking symptoms of a posterior fossa mass. We conclude that computed tomographic scans, magnetic resonance imaging studies, bone scans indium-labeled white blood cell scans, and gallium scans are useful in making the diagnosis. A biopsy of the bony lesion often is needed to identify the causative organism and to rule out a tumor. Intravenously administered antibiotics are the mainstay of therapy and should be continued until 1 week after the gallium scan shows no abnormalities. Follow-up gallium scans then are done at 1 week and 3 months after the cessation of antibiotic therapy to search for a recurrence.
Malone
D G
DG
Division of Neurosurgery, University of Kansas Medical Center, Kansas City.
O'Boynick
P L
PL
Ziegler
D K
DK
Batnitzky
S
S
Hubble
J P
JP
Holladay
F P
FP
D000328:Adult; D000900:Anti-Bacterial Agents; D003389:Cranial Nerve Diseases / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003952:Diagnostic Imaging; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D005710:Gallium Radioisotopes; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008417:Mastoiditis / Q000150:complications / Q000382:microbiology / Q000601:surgery; D016920:Meningitis, Bacterial / Q000150:complications; D008875:Middle Aged; D009777:Occipital Bone; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D010034:Otitis Media with Effusion / Q000150:complications; D011183:Postoperative Complications; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy; D011877:Radionuclide Imaging; D012008:Recurrence; D013100:Sphenoid Bone; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D005710:Gallium Radioisotopes