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 postantibiotic 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. (c) 2005 by Elsevier Inc. All rights reserved.