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Internal carotid artery aneurysm in skull base osteomyelitis: does the pattern of cranial nerve involvement matter?

  • F Hassannia (a1), S D Carr (a1), E Yu (a1) and J A Rutka (a1)

Abstract

Objective

Carotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.

Methods

Two diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.

Results

Internal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.

Conclusion

One should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.

Copyright

Corresponding author

Author for correspondence: Dr Fatemeh Hassannia, Department of Otolaryngology – Head and Neck Surgery, University Health Network, Toronto, Ontario M5G 2C4, Canada E-mail: fatimahassannia@yahoo.com

Footnotes

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Dr F Hassannia takes responsibility for the integrity of the content of the paper

Footnotes

References

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1Mani, N, Sudhoff, H, Rajagopal, S, Moffat, D, Axon, PR. Cranial involvement in malignant external otitis: implication for clinical outcome. Laryngoscope 2007;117:907–10
2Chandler, JR. Malignant external otitis. Laryngoscope 1968;78:1257–94
3Rowlands, RG, Lekakis, GK, Hinton, AE. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy. J Laryngol Otol 2002;116:556–8
4Corey, JP, Levandowski, RA, Panwalker, AP. Prognostic implications of therapy for necrotizing external otitis. Am J Otol 1985;6:353–8
5Tanaka, H, Patel, U, Shrier, DA, Coniglio, JU. Pseudo-aneurysm of the petrous internal carotid artery after skull base infection and prevertebral abscess drainage. Am J Neuroradiol 1998;19:502–4
6Mangat, SS, Nayak, H, Chandna, A. Horner's syndrome and sixth nerve paresis secondary to a petrous internal carotid artery aneurysm. Semin Ophthalmol 2011;26:23–4
7Costantino, PD, Russell, E, Reisch, D, Breit, RA, Hart, C. Ruptured petrous carotid aneurysm presenting with otorrhagia and epistaxis. Am J Otol 1991;12:378–83
8Oliveira, AR, Trigo, D, Castanho, P, Marques, C, Almeida, J. Collet–Sicard syndrome complicating internal jugular vein thrombosis. Eur J Intern Med 2013;24:70–2
9Bien, AG, Cress, MC, Nguyen, SB, Westagate, SJ, Nanda, A. Endovascular treatment of a temporal bone pseudo-aneurysm presenting as bloody otorrhea. J Neurol Surg Rep 2013;74:8891
10McGrail, KM, Heros, RC, Debrum, G, Beyerl, BD. Aneurysm of the ICA petrous segment treated by balloon entrapment after EC-IC by-pass. Case report. J Neurosurg 1986;65:249–52

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