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Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis

Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chroni...

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Autores principales: van der Valk, Jens, Treurniet, Frank, Koopman, Jan Pieter, Koppen, Hille
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738220/
https://www.ncbi.nlm.nih.gov/pubmed/31543800
http://dx.doi.org/10.1159/000500240
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author van der Valk, Jens
Treurniet, Frank
Koopman, Jan Pieter
Koppen, Hille
author_facet van der Valk, Jens
Treurniet, Frank
Koopman, Jan Pieter
Koppen, Hille
author_sort van der Valk, Jens
collection PubMed
description Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae. The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia.
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spelling pubmed-67382202019-09-22 Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis van der Valk, Jens Treurniet, Frank Koopman, Jan Pieter Koppen, Hille Case Rep Neurol Case Report Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae. The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia. S. Karger AG 2019-05-21 /pmc/articles/PMC6738220/ /pubmed/31543800 http://dx.doi.org/10.1159/000500240 Text en Copyright © 2019 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/4.0/ This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
spellingShingle Case Report
van der Valk, Jens
Treurniet, Frank
Koopman, Jan Pieter
Koppen, Hille
Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title_full Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title_fullStr Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title_full_unstemmed Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title_short Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis
title_sort severe daily headache as an uncommon manifestation of widespread skull base osteomyelitis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738220/
https://www.ncbi.nlm.nih.gov/pubmed/31543800
http://dx.doi.org/10.1159/000500240
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