A 4-year-old girl was admitted to the Department of Pediatrics, University of Chieti, Italy, with a 2-week history of fever and right otitis media, headache and vomiting. Exam showed right facial and abducens nerve palsies. CT scan showed a right mastoiditis. MRI revealed ipsilateral sinus thrombophlebitis. Complete resolution followed treatment with high dose IV antibiotics and oral anticoagulants.[1]

COMMENT. Otitis media, pain in the distribution of the first and second branches of the trigeminal nerve, and ipsilateral abducens palsy are the three characteristic signs of Gradenigo’s syndrome. Facial nerve palsy occurs in severe cases, as above. Otitis media and inflammation spread to involve the petrous apex, dura and lateral venous sinus. Irritation of the ophthalmic branch of the trigeminal nerve and sixth nerve follow. The nerve involvement may be delayed for 1 to 3 months. The syndrome is now rare, but early diagnosis is important, to avoid necessity for surgery.