TITLE:
Skull Base Osteomyelitis: A Rare Cause of Multiple Cranial Nerve Palsies—A Case Report from Ghana
AUTHORS:
Ekins Kuuzie, Prince Kwabla Pekyi-Boateng, Annie Yennah, Fiifi Duodu
KEYWORDS:
Skull Base Osteomyelitis, Cranial Nerves, Malignant Otitis Externa, Bulbar Palsy, Fungal Infection
JOURNAL NAME:
World Journal of Neuroscience,
Vol.13 No.4,
November
28,
2023
ABSTRACT: Introduction: Skull
Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that
is often caused by malignant otitis externa (MOE) and affects the temporal
bone. This condition commonly affects immunocompromised individuals and the
elderly, particularly those with a history of diabetes mellitus. Diagnosis is
challenging because of non-specific symptoms that lead to late detection and
complications. This report discusses a case of SBO with multiple bilateral
cranial nerve abnormalities and highlights the diagnostic and management
challenges in high-risk individuals with subtle clinical signs. Case
presentation: This report describes a 63-year-old patient with hypertension
and diabetes who underwent surgical debridement of the left ear due to
malignant otitis externa 4 months prior to presentation. The patient presented
with significant dysarthria, dysphagia, ptosis of the left eye with double
vision, and hearing impairment in the left ear. Examination revealed bilateral
CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII
deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI
revealed a pathological process in the base of the skull involving bony
structures and cranial nerves bilaterally, which helped diagnose SBO. The
patient was subsequently discharged with oral voriconazole and continued his
usual medications. The patient requested further management abroad, because he
did not notice resolution of his symptoms. Surgical treatment was employed
abroad to relieve his symptoms, as he recovered slowly. Conclusion: This
case report underscores the importance of a multidisciplinary approach to
address SBO. Collaboration between specialists in infectious diseases,
otolaryngology, radiology, and neurology plays a pivotal role in achieving an
accurate diagnosis and developing a tailored treatment plan. Although SBO may
be infrequent, this case report highlights the need to maintain heightened
clinical suspicion in high-risk individuals.