Indian journal of ophthalmology · 2026
Nerve-rattling infections! Clinical and radiological tracing of cranial nerve palsies to infectious skull base osteomyelitis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Sharanya R, Shah Pankti, Mani Karthik K, Muralitharan Pushkaran, Ramasamy Rajkumar, Shah Virna M
Аннотация
PURPOSE: To analyze skull base osteomyelitis as a cause of isolated and multiple cranial nerve palsies. Report presentations of otogenic and non-otogenic types. Emphasize the importance of neuroimaging with contrast at the first visit.
DESIGN: Single-center retrospective observational study.
SETTING: Institutional.
STUDY POPULATION: A total of 276 patients with cranial nerve palsies over a period of four months. Of these, 20 patients with SBO were included in the study.
OBSERVATION PROCEDURE: Complete ocular examination and magnetic resonance imaging (MRI) of the brain and orbit with contrast for all patients.
MAIN OUTCOME MEASURE: Radiological/microbiological diagnosis of SBO.
RESULTS: Most of our patients were between 70 and 75 years. Time from the onset of symptoms to presentation was between one week and one month. A total of 75% had diabetes mellitus. A total of 90% had unilateral presentation. Most common presenting symptom was double vision and headache seen in 45%. A total of 70% had a non-otogenic source of infection. Sphenoid sinus was involved in 50%. MRI of brain and orbit with contrast showed sinusitis in 45% and otomastoiditis in 35%. Fungi were isolated on biopsy in 30%, bacteria in 15%, acid-fast bacilli in 5%. Intravenous antibiotics were given to 55% and intravenous antifungal was given to 25%. Transnasal sinus surgery was performed in 30%.
CONCLUSION: Isolated cranial palsy does not exclude infectious etiology even if patient has comorbidities like uncontrolled diabetes, particularly if associated with headache and pain. Hence, neuroimaging with contrast is required.
DESIGN: Single-center retrospective observational study.
SETTING: Institutional.
STUDY POPULATION: A total of 276 patients with cranial nerve palsies over a period of four months. Of these, 20 patients with SBO were included in the study.
OBSERVATION PROCEDURE: Complete ocular examination and magnetic resonance imaging (MRI) of the brain and orbit with contrast for all patients.
MAIN OUTCOME MEASURE: Radiological/microbiological diagnosis of SBO.
RESULTS: Most of our patients were between 70 and 75 years. Time from the onset of symptoms to presentation was between one week and one month. A total of 75% had diabetes mellitus. A total of 90% had unilateral presentation. Most common presenting symptom was double vision and headache seen in 45%. A total of 70% had a non-otogenic source of infection. Sphenoid sinus was involved in 50%. MRI of brain and orbit with contrast showed sinusitis in 45% and otomastoiditis in 35%. Fungi were isolated on biopsy in 30%, bacteria in 15%, acid-fast bacilli in 5%. Intravenous antibiotics were given to 55% and intravenous antifungal was given to 25%. Transnasal sinus surgery was performed in 30%.
CONCLUSION: Isolated cranial palsy does not exclude infectious etiology even if patient has comorbidities like uncontrolled diabetes, particularly if associated with headache and pain. Hence, neuroimaging with contrast is required.