Sixth and tenth nerve palsy secondary to pseudomonas infection of the skull base.

PURPOSE: To describe skull base osteomyelitis, an uncommon complication of chronic otitis media in the post-antibiotic era, as a cause for diplopia.

DESIGN

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.