Sixth and tenth nerve palsy secondary to pseudomonas infection of the skull base.
OBJECTIVE
To describe skull base osteomyelitis, an uncommon complication of chronic otitis media in the post-antibiotic era, as a cause for diplopia.


METHODS
Case report.


METHODS
The records of a patient with skull base osteomyelitis were reviewed.


RESULTS
A patient presented with a sixth nerve palsy and tenth nerve palsy. Magnetic resonance imaging, bone scan, and gallium scan were helpful in establishing the diagnosis. Cultures grew Pseudomonas. The treatment required long-term intravenous antibiotics.


CONCLUSIONS
Pseudomonas skull-based osteomyelitis can produce a sixth nerve palsy as a result of the involvement of the clivus. Although uncommon in the post-antibiotic era, early recognition, appropriate diagnostic testing, and aggressive systemic antibiotic treatment might prevent permanent neurologic sequel.
Kulkarni
Sonalee
S
Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP, Iowa City, IA 52242, USA. andrew-lee@uiowa.edu
Lee
Andrew
A
Lee
John H
JH
D020434:Abducens Nerve Diseases / Q000209:etiology*; D000368:Aged; D000900:Anti-Bacterial Agents; D004172:Diplopia / Q000209:etiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010033:Otitis Media / Q000150:complications; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011877:Radionuclide Imaging; D019291:Skull Base / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D020421:Vagus Nerve Diseases / Q000209:etiology*
D000900:Anti-Bacterial Agents