CASE HISTORY / CLINIC:
Patient with sudden onset of left-sided abducens paralysis. Left temporal pains. Normal findings of ear microscopy. No hearing impairment.


FINDINGS:
The post-contrast T1-weighted axial image of the cerebellopontine angle shows a prominent signal enhancement of the whole apex of the left petrous pyramid (upper picture), whereas the right petrous pyramid appears normal.
The apex of the left petrous pyramid appears opacified, the trabecular structure appears blurred in the axial CT-image through the petrous bone (lower picture). The apex of the right petrous pyramid is pneumatized and has a appears normal.


DIAGNOSIS:
Gradenigo's syndrome


DIFFERENTIAL DIAGNOSIS:
Tumorous changes around the petrous apex.


Web resources:

1) Gesundheit.de
2) Amersham Health