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A child with Gradenigo syndrome presenting with meningism: a case report.

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dc.contributor.author Athapathu, A. S.
dc.contributor.author Bandara, E. R. S.
dc.contributor.author Aruppala, A. A. H. S.
dc.contributor.author Chandrapala, K. M. A. U.
dc.contributor.author Mettananda, S.
dc.date.accessioned 2019-10-26T07:46:09Z
dc.date.available 2019-10-26T07:46:09Z
dc.date.issued 2019
dc.identifier.citation BMC Pediatrics.2019;19(1):350 en_US
dc.identifier.issn 1471-2431 (Electronic)
dc.identifier.uri http://repository.kln.ac.lk/handle/123456789/20452
dc.description indexed in MEDLINE en_US
dc.description.abstract BACKGROUND:The symptoms of meningitis which include fever, headache, photophobia and irritability along with abducens nerve palsy pose a diagnostic dilemma requiring urgent attention. Here we report how such a dilemma was methodically and sequentially resolved using anatomical knowledge supported by neuroimaging and the eventual diagnosis of Gradenigo syndrome was made.CASE PRESENTATION:A 6-year-old previously healthy boy from Sri Lanka presented with high grade fever, headache, photophobia and left eye pain for 10 days and diplopia for 2 days duration. Neurological examination was unremarkable except for left sided abducens nerve palsy. He had high inflammatory markers and white blood cell count. A tentative differential diagnosis of acute bacterial meningitis complicated by cerebral oedema, acute hydrocephalus or cerebral abscess was made. However, non-contrast CT brain, cerebrospinal fluid analysis and electroencephalogram were normal leading to a diagnostic dilemma. MRI brain with contrast performed 3 days later due to limited resources revealed left mastoiditis extending to petrous temporal bone confirming Gradenigo syndrome.CONCLUSION:This case report highlights the importance of a thorough physical examination in children presenting with unrelated neurological symptoms and signs. Unilateral abducens nerve palsy raises the suspicion of increased intracranial pressure and neuroimaging is vital in diagnostic uncertainties. Gradenigo syndrome emphasises the importance of incorporating anatomical knowledge into clinical practice. en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.subject Abducens nerve palsy en_US
dc.title A child with Gradenigo syndrome presenting with meningism: a case report. en_US
dc.type Article en_US


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