Complicaciones de la otitis media con parálisis del sexto par craneal contralateral en pediatría / Cranial complications of otitis media with paralysis of the contralateral sixth cranial pair in pediatrics

Resumen. La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.

Abstract. Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.

Síndrome de Gradenigo: una complicación poco frecuente de la otitis media aguda / Gradenigo syndrome: a rare complication of acute otitis media

El síndrome de Gradenigo consiste en una tríada clínica dada por otitis media aguda, parálisis unilateral del VI par craneano y dolor retroorbitario ipsilateral. Se atribuye a una petrositis apical aguda, complicación evolutiva de una infección del oído medio. La disponibilidad, el acceso y el uso adecuado de la terapia antibiótica han contribuido a una disminución de la frecuencia de estas complicaciones intratemporales o intracraneales de elevado riesgo de morbimortalidad. El tratamiento de la petrositis aguda ha evolucionado, desde la cirugía radical en la era preantibiótica, al tratamiento médico y cirugía menor combinados, en los últimos años. La oftalmoplejia externa plantea diagnósticos diferenciales con otras entidades clínicas: traumatismos, neoplasias, hipertensión endocraneana y procesos infecciosos intracraneales, como trombosis del seno venoso lateral, abscesos intracraneales epi y subdurales. En esta comunicación se jerarquiza el reconocimiento oportuno de las manifestaciones clínicas de esta complicación poco frecuente con el objetivo de sensibilizar a los profesionales para su abordaje diagnóstico y terapéutico oportuno y adecuado.

The Gradenigo syndrome consists in a clinical triad of acute otitis media, unilateral paralysis of the VI cranial nerve and ipsilateral retroorbital pain. It is attributed to an acute apical petrositis by evolutionary complication from an infection of the middle ear. The availability, the access and adequate use of antibiotic therapy have contributed to decrease the frequency of this intratemporal or intracranial complications with high risk of morbidity and mortality. The treatment of acute petrositis has evolved from radical surgery in the pre-antibiotic era, to medical treatment and minor surgery combined, in recent years. The external ophthalmoplegia raises differential diagnosis with other clinical entities: trauma, neoplasms, endocranial hypertension and intracranial infections like venus thrombosis of the lateral sinus, epi and subdural abscesses. In this communication we rank the early recognition of the clinical manifestations of this rare complication to sensitize the professionals for its diagnostic and therapeutic approach timely and adequate.

Aspectos tomográficos da órbita aguda infecciosa: revisão de literatura / Tomographic findings of acute infections of the orbit: literature review

As doenças que acometem a órbita de forma aguda e não traumática por vezes não são conhecidas por médicos em centros de emergência. Essas condições são decorrentes de diversos fatores, como desordens imunológicas, congênitas, infecciosas, vasculares, entre outras. As causas infecciosas correspondem a mais de 50% de todos os casos e requer rápido diagnóstico e conduta para minimização de sequelas. A tomografia computadorizada (TC) é o exame de imagem de primeira linha nesses casos, sendo geralmente disponível nos centros de emergência e capaz de fornecer auxílio diagnóstico de forma rápida, precisa e eficaz. Esse artigo de revisão visa descrever os principais aspectos tomográficos da órbita aguda infecciosa, correlacionando-os com os dados da literatura.

The acute and nontraumatic diseases that involve the orbit are often little known by most physicians. These conditions are due to several factors, such as immune disorders, congenital, infections, vascular, among others disorders. The infectious causes correspond to more than 50% of all cases and require rapid diagnosis and management in order to minimize sequels. Computed tomography (CT) is the first line imaging method on these cases, generally being available in emergency centers and capable to provide an accurate, quick and effective diagnostic information. This review article aims to describe the main tomographic findings in acute orbit infections, correlating them with the literature data.