Headache Attributed to Petrous Apicitis without Symptoms of Acute Otitis Media

The classical findings of petrous apicitis, also known as Gradenigo’s syndrome, include abducens nerve palsy, deep facial pain and symptoms of acute otitis media. With the widespread use of antibiotics, petrous apicitis has become an uncommon disease. However, when it occurs, it may be silent or inconspicuous at first and gradually progress to a life-threatening stage. Petrous apicitis has conventionally been treated with aggressive surgical methods. However, recent reports have described good outcomes of more conservative medical treatments with minimal surgical intervention. Here, we report a case involving a 12-year-old child with petrous apicitis without symptoms of acute otitis media, who presented with persistent headaches since 14 days. On day 2 of admission, he developed diplopia and lateral limitation of the left eye. Medical treatment resulted in favorable outcomes, and the child was in good health without headaches or abducens nerve palsy at the 2-month follow-up.