title: [Gradenigo syndrome as the form of presentation of nasopharyngeal carcinoma].
abstract: BACKGROUND
  Nasopharyngeal carcinoma is a condition which usually has an insidious onset and non-specific features in the initial stages, so it is difficult to make an early diagnosis. The most usual presenting features are otological (serous otitis media) and involvement of adjacent cranial nerves. We report a case of Gradeningo's syndrome due to the tumour spreading towards the base of the skull. We review the literature on the aetiology of this syndrome.
  
  
  METHODS
  A 53 year old patient required neurological assessment for a clinical condition which was compatible with Gradenigo's syndrome that involved both right V and VI cranial nerves. This study permitted diagnosis of a nasopharyngeal carcinoma which had been undetected because of its non-specific features, until this complication occurred. Otorhinolaryngological assessment proved the presence of a neoplasm in the cavum. Biopsy of the lesion showed it to be a well-differentiated squamous cell carcinoma. Cranial magnetic resonance imaging showed extension of the tumour to the base of the skull, adjacent to the right sinus cavernosus. The cerebrospinal fluid was normal. Treatment by radiotherapy was indicated.
  
  
  CONCLUSIONS
  Diagnosis of nasopharyngeal carcinoma requires a high index of suspicion in view of its initial, sparse, non-specific symptoms. Although ideally the disease should be detected in its early stages, we believe that it is useful to recommend that in cases of Gradenigo's syndrome a full systematic otorhinolaryngological exploration be made so as to effectively rule out this disorder.
authors.affiliation: Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España. mpenas@wanadoo.es
authors.forename: M
authors.initials: M
authors.lastname: Penas-Prado
authors.forename: J
authors.initials: J
authors.lastname: Díaz-Guzmán
authors.forename: I
authors.initials: I
authors.lastname: Jiménez-Huerta
authors.forename: R
authors.initials: R
authors.lastname: Juntas-Morales
authors.forename: A
authors.initials: A
authors.lastname: Villarejo-Galende
authors.forename: I
authors.initials: I
authors.lastname: Díez-Torres
mesh_terms: D000010:Abducens Nerve / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology; D013577:Syndrome; D014276:Trigeminal Nerve / Q000473:pathology