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Case Reports in Otolaryngology
Volume 2016, Article ID 9252361, 4 pages
http://dx.doi.org/10.1155/2016/9252361
Case Report

A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

1Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Bandaihigashi 3-1-56, Sumiyoshi-ku, Osaka 558-8558, Japan
2Department of General Internal Medicine, Osaka General Medical Center, Bandaihigashi 3-1-56, Sumiyoshi-ku, Osaka 558-8558, Japan
3Department of Neurology, Osaka General Medical Center, Bandaihigashi 3-1-56, Sumiyoshi-ku, Osaka 558-8558, Japan

Received 3 May 2016; Revised 10 June 2016; Accepted 25 July 2016

Academic Editor: Harukazu Hiraumi

Copyright © 2016 Haruka Miyabe et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.